Getting a COVID-19 diagnostic test in DC? It'll cost you.
The cost of a COVID-19 test varies widely, depending on where you get tested and even what state you reside in.
Welcome to the U.S. health care system, where the prices are made up and the actual cost doesn’t matter. Case in point: COVID-19 diagnostic testing. Most insured individuals will likely not see a bill for testing, leaving them completely in the dark on how much their health provider is actually charging–and how much their insurer is paying.
The cost of COVID-19 tests has varied widely since the pandemic began, and average prices are difficult to pin down. Providers determine their own charges, with no variation among different insurance types.
Related: The question of who pays for COVID testing is getting more complicated
SpringerLink, a comprehensive online collection of scientific information, obtained data from more than 180,000 diagnostic and nearly 320,000 antibody test claims to calculate average prices. Test fees are especially important for out-of-network plans, uninsured patients and others with little negotiating power.
The CARES Act requires private plans without a negotiated rate with the provider to pay the price publicly listed by the provider, which usually is the full amount or a percentage of the charge. Providers who test uninsured patients can seek reimbursement from either the Department of Health and Human Services or by billing patients at a self-determined price. As a result, the higher the charge for COVID-19 tests, the higher the potential cost exposure for plans without negotiating power and for uninsured patients.
Researchers determined the average charges for the most common types of diagnostic and antibody tests. The average costs for diagnostic tests are is $144.06, while the median cost is $100.
Independent labs performed nearly half of all diagnostic tests, with an average charge of $140.41. Hospital outpatient settings, which performed 35% of tests, charged an average of $168.87. Charges varied widely by state, from a low of $64.98 in Utah to a high of $505.65 in Washington, D.C.
The study found these costs for antibody tests average $63.92, with a median price of $55.
Independent labs performed 97 percent of all antibody tests. The charges for these tests also varied by state, from a low of $45.85 in New York to a high of $195.41 in New Mexico The Medicare reimbursement rates are $51.31 for diagnostic tests and $42.13 for antibody tests.
“A small proportion of COVID-19 diagnostic tests and antibody tests services, provided in selected states, had charges that far exceeded the Medicare rate,” researchers concluded. “High charges may create financial barriers for some uninsured patients and lead to higher premiums for out-of-network private plans.”
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