Anew study from Avalere Health refutes past claims that commercial health plans pay lower rates for lab services than Medicare.Commissioned by the American Clinical Laboratory Association (ACLA), Avalere’s study compared private data for a mix of 27 lab test codes representing low-dollar and high-dollar tests, which constituted nearly half of Medicare spending in the 2011 Clinical Laboratory Fee Schedule—including the top four codes by Medicare spending. The study included data from both hospital and independent labs. The study found that for every high-volume code reviewed, Medicare paid lower rates than the weighted commercial mean price. For example, commercial payers paid an average of $20.26 for a complete blood count (CBC), while Medicare’s price is almost half at $11.02. For column chromatography for drug screening, commercial payers paid $69.48 and Medicare paid $25.57. Commercial rates grew even more expensive than Medicare when services were provided in rural areas. For example, the study found that rates could more than double in low-volume areas such as Boise, Idaho, compared to high-volume areas such as New York. For 15 common lower-priced tests, the average Medicare national limit is $11.82 while the average overall commercial mean price is $19.14, according to Avalere’s analysis. For 12 high-priced tests, the Medicare national limit is $168.09 while the overall commercial mean price is $188.79. Avalere’s findings contrast with earlier studies which ACLA says failed to consider more than half of the private market. A June 2013 report by the Department of Health and Human Services Office of Inspector General (OIG) claimed that private payers receive a better deal on lab services than Medicare (NIR, June 27, 2013, p. 1). Based on its analysis, the OIG concluded that in 2011, Medicare paid between 18 percent and 30 percent more than other insurers for 20 high-volume or high-expenditure lab tests. Medicare could have saved $910 million on these tests if it had paid providers at the lowest established rate in each geographic area, the OIG said.