When U.S. health care providers give COVID-19 tests inside a health insurer’s provider network, the average cost is about $130, according to America’s Health Insurance Plans (AHIP).
When providers give COVID-19 tests to out-of-network patients — without having to comply with the pricing rules in a provider network agreement — the average price is $185, AHIP says.
Providers charged $380 or more for 12% of the out-of-network COVID-19 diagnostic tests given, AHIP says.
- A copy of the AHIP COVID-19 test price analysis is available here.
- An article about a balance billing hearing is available here.
AHIP has based the COVID-19 test price figures on results from a survey of 22 insurers. It weighted the responses by insurer enrollment.
COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
AHIP collected in-network and out-of-network price data for SARS-CoV-2 antibody tests and antigen tests as well as for SARS-CoV-2 diagnostic tests.
The percentage of out-of-network tests costing less than $260, or twice the in-network price average, was 76% for diagnostic tests, 77% for antibody tests, and 79% for antigen tests.
Commercial health insurers often base the rates they pay for a service on a multiple of what the traditional Medicare program pays.
Medicare program managers said in October that they will pay $100 for diagnostic tests processed by labs that usually report results within two days, and $75 for tests processed by labs that usually take longer than two days.
— Read Health Plans Must Post Doctor Care Cost Estimators by 2023: Federal Regulators, on ThinkAdvisor.