How Are Medical Laboratory Tests Prices Derived?


Quick Answer

The prices charged to patients for medical tests have traditionally been set by insurance companies based on the rates that the test provider itself charges, according to Consumer Reports. Some insurance companies may adjust their reimbursement based on data collected by outside companies, such as Fair Health. There has also been a trend towards standardizing prices for tests based on the Medicare reimbursement rate for the procedure.

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Full Answer

Prices for many laboratory tests for Medicare recipients are set through the government's Medicare reimbursement rate, according to the Centers for Medicare and Medicaid Services. These reimbursement rates are defined for specific tests and may vary by local or national fee limits. Though these reimbursements normally only apply to Medicare patients, many insurance companies and health care providers have begun to standardize their prices for medical laboratory tests to between 110 and 150 percent of the Medicare reimbursement rate, writes Consumer Reports.

Competition among laboratories providing medical testing services also drives medical test pricing, according to Dark Daily. Consumers with access to pricing information about medical tests actively shop for lower prices for the procedures they need. This has induced more price competition among test providers and driven test prices down as a whole.

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