Commercial price variation in precision oncology testing across US hospitals.

Abstract

11062 Background: Precision oncology testing using clinically validated biomarker tests is standard of care for solid tumors and is endorsed by clinical guidelines and professional societies. However, these tests represent a substantial and growing component of cancer care costs. Commercial payer-negotiated prices for these tests and their variation across hospitals and payers have not been examined. Methods: We conducted a cross-sectional analysis of hospital-reported commercial payer-negotiated prices, aggregated by Turquoise Health as of January 2026, for biomarker tests commonly used in breast, colon, and non-small cell lung cancer and identified using the National Comprehensive Cancer Network Biomarkers Compendium and Centers for Medicare and Medicaid Services Clinical Laboratory Fee Schedule. We included tests with unique Current Procedural Terminology codes and extracted prices negotiated between short-term acute care hospitals and the four largest US payers (Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare). Prices were adjusted using ZIP code-level Geographic Adjustment Factors. We assessed within- and between-hospital variation in prices for each test using the median 90th-to-10th percentile price ratio and compared prices across payers using Kruskal-Wallis tests. Results: We identified 422,515 payer-negotiated prices for 28 biomarker tests from 2,142 US hospitals. Oncotype DX Breast Recurrence Score and CEA expression testing were the most frequently reported panel- and non-panel-based tests, with median (interquartile range [IQR]) prices of $4,129 ($3,869–$10,680) and $28 ($20–$59), respectively, across hospitals. The percentage of hospitals reporting negotiated prices, price amounts, and price variation are summarized in the Table. Cigna had the highest prices for 20 (71.4%) tests, whereas UnitedHealthcare had the lowest price for all tests. Conclusions: Commercial payer-negotiated prices for precision oncology testing varied substantially across payers and hospitals, with greater variation between than within hospitals for the same tests. Given the central role of these biomarker tests in guideline-recommended cancer care, price variation has important implications for payer spending, clinical decision-making, patient out-of-pocket costs, and equitable care access. Price variation for precision oncology testing. Biomarker Tests Percentage of hospitals in Turquoise Health database reporting negotiated price, Median (IQR) Negotiated price, USD, Median (IQR) Within-hospital ratios, Median (IQR) 1 Between-hospital ratios, Median (IQR) 1 Panel-based (N=13) 18.3% (17.2%-18.8%) $3,704 ($3,096-$4,129) 1.5 (1.4-1.5) 5.5 (5.5-5.6) Non-panel-based (N=15) 30.3% (22.2%-37.8%) $301 ($157-$485) 1.6 (1.5-1.7) 5.2 (5.1-5.4) 1 Median (IQR) of ratios of the 90 th :10 th percentile payer-negotiated prices within each hospital and across all hospitals for the same test.