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Tumor Marker Test, Positive or Negative

New York rates for HCPCS 86294

An antibody-based laboratory test that looks for a tumor-associated substance in a sample and reports the answer as positive or negative, or as a rough level, rather than an exact figure. A common use is checking urine for a bladder cancer marker in someone being monitored after treatment.

Rates data updated July 2026.

How much does Tumor Marker Test, Positive or Negative cost?

$21.88

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $21.88 for this service. The price depends on where it is billed: about $15.85 from a physician practice, and about $38.02 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$15.85$12.02 to $25.70
FacilityA hospital or hospital-owned outpatient department$38.02$25.70 to $58.88

How much rates vary

Facilitymedian $38 · 10th to 90th $18 to $71Professionalmedian $16 · 10th to 90th $10 to $40
$10$20$50$100facility $38professional $16

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$18.20
Median
$42.66
Typical High
$70.79
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$17.78
Typical High
$25.70
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$25.70
Typical High
$66.07
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$13.18
Typical High
$45.71
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$15.49
Median
$25.70
Typical High
$25.70
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$25.70
Typical High
$25.70
Cigna
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$54.95
Typical High
$177.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$33.88
Typical High
$123.03
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$10.00
Median
$25.70
Typical High
$57.54
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$15.49
Typical High
$50.12
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$13.49
Typical High
$26.92
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$45.71
Typical High
$257.04
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$16.60
Median
$27.54
Typical High
$52.48
United
Setting
Facility
Modifier
Global
Typical Low
$15.49
Median
$27.54
Typical High
$32.36
United
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$15.85
Typical High
$57.54
Univera
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$9.77
Typical High
$29.51
Univera
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$21.88
Typical High
$53.70

Where New York sits

The same service costs 2.7 times more in South Dakota than in Florida. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

New York· 33rd of 51

$21.88

SD $48.98FL $18.20

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.