go back

Tumor Marker Test, Positive or Negative

Pennsylvania 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 Pennsylvania, July 2026.

Insurers have agreed to pay about $21.88 for this service. The price depends on where it is billed: about $20.89 from a physician practice, and about $38.90 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 8 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$20.89$19.95 to $23.99
FacilityA hospital or hospital-owned outpatient department$38.90$28.84 to $70.79

How much rates vary

Facilitymedian $39 · 10th to 90th $22 to $95Professionalmedian $21 · 10th to 90th $14 to $39
$10$20$50$100facility $39professional $21

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
$21.88
Median
$38.90
Typical High
$95.50
Aetna
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$20.89
Typical High
$60.26
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$89.13
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$19.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$18.20
Median
$37.15
Typical High
$87.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$25.12
Typical High
$38.02
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$15.14
Typical High
$37.15
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$25.70
Typical High
$25.70
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$18.62
Typical High
$44.67
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$20.89
Median
$38.90
Typical High
$93.33
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$20.89
Typical High
$75.86
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$27.54
Typical High
$63.10
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$17.38
Typical High
$17.38
United
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$25.70
Typical High
$30.90
United
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$15.85
Typical High
$35.48

Where Pennsylvania 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.

Pennsylvania· 32nd 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.