In economic theory, one would expect the price of a test to be the market-clearing price, etc, from MBA 101.
The actual pricing of high-cost lab tests is different. IPO filings for genomic laboratories often state, 'In many cases we do not know if we will get paid, when we will get paid, or how much we will be paid."
One unique insight was the distribution of reporting commercial payor pricing that CMS released in a cloud database at the time of the first PAMA survey (prices for 1H2016 reported in 1Q2017). i have a file of all the prices paid for 81211 (BRCA) in 2016, as reported to CMS.
While the 2017 fee schedule 81211 (BRCA 1&2&DUPDEL) was $2396, the survey median was $2195. But that was not a median with a Gaussian surround.
Rather, as shown in the figure, the prices received by labs (and in 2016, this was still highly dominated by Myriad) were very spiky. (The graph shows the top 10 most-paid price points). The simplest takeaway is that the market behaved very differently than a simple average price with a stddev around it.
I believe at the time, 2017, CMS posted a cloud database with all pricing data. For example, a single lab reporting a single code might have reported, 81211, $2106, 3 payments. $2137, 1 payment, $2140, 9 payments. Add that up across all labs and all codes and that was the cloud database. I don't think it's still posted: I had an old 2017 download to excel of the part of the data for 81211.
