I can't speak to the pricey part due to the way my insurance works. @markymarkfl has always said that he independently found a lab that would do the draw and process the test for a very reasonable out-of-pocket fee (I think $25). Whatever you wind up doing, be sure to have the test processed at the same lab each time. The results apparently can vary if the processing facility changes. Re the reliability of the test, you're right--the CA 19-9 isn't the ultimate authority. In particular, it's a lousy diagnostic tool. However, it can be a good tool to track treatment progress and disease status.