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Tumor Marker Test, Positive or Negative

Vermont 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 October 2026.

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

$30.90

Typical negotiated rate. In Vermont, October 2026.

Insurers have agreed to pay about $30.90 for this service. The price depends on where it is billed: about $29.51 from a physician practice, and about $151 from a hospital or other facility.

Few insurers publish rates for this combination, so treat this figure as a rough guide.

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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$29.51$16.60 to $33.88
FacilityA hospital or hospital-owned outpatient department$151$42.66 to $331

How much rates vary

Facilitymedian $151 · 10th to 90th $26 to $347Professionalmedian $30 · 10th to 90th $15 to $38
$10$20$50$100$200facility $151professional $30

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$33.88
Median
$33.88
Typical High
$33.88
BCBS Vermont
Setting
Facility
Modifier
None
Typical Low
$151.36
Median
$331.13
Typical High
$346.74
Cigna
Setting
Facility
Modifier
None
Typical Low
$42.66
Median
$42.66
Typical High
$42.66
Cigna
Setting
Professional
Modifier
None
Typical Low
$15.85
Median
$30.20
Typical High
$36.31
MVP Health Care
Setting
Facility
Modifier
None
Typical Low
$25.70
Median
$25.70
Typical High
$25.70
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$16.60
Median
$16.60
Typical High
$16.60
United
Setting
Professional
Modifier
None
Typical Low
$11.75
Median
$17.38
Typical High
$43.65

Where Vermont sits

The same service costs 3.8 times more in Alaska than in Alabama. 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.

Vermont· 10th of 51

$30.90

AK $57.54AL $15.14

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.