CMS has posted data on PAMA pricing for laboratory tests. The private payor payment rates, effective in 1H2025, are used to set a new clinical laboratory fee schedule for 2027 forward. CMS posted some statistics as well.
See a Fact Sheet about the rates:
And a press release:
Find resources such as data ZIP files here:
There is an "all data" XLS file that unzips to about 100 mb, in giant pages of about 1M rows (999,999). (It looks like 7 worksheets, or circa 7M lines).
One common molecular code, 81455 (51 or more tumor genes) drops 2%, from $2919 to $2861 (minus $58).
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The raw data shows extensive price range and price distribution data. Reporting hospital labs rose from 21 in 2017 to 875 in 2026. Physician office labs rose from 1106 to 3262. Independent labs were about the same (658, 775).
Data for sole-source tests aren't provided as raw data. For example, we don't know the price range or distribution for 81519, Oncotype Dx - it's not not in the public full data table. The median price did not change (81519, $3873 before, $3873 after). The 70-gene test, Mammaprint, fell from $3873 to $3075.
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According to the Fact Sheet, 1171 codes have a lower median, and 169 have the same median. 186 codes have a higher median than in 2026.
Major code categories - chemistry, mopath, microbiology, immunology - generally fell 15-20%. PLA codes fell only -2%.
The easiest file to review is:
5 CY_2027_Prelim_Wgt_Meds_Pmt_Rates_2026.09.21.xlsx
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The highest code, 0211U, Caris, $8455, was unchanged. 0067U rose from $1897 to $3330. 0084U rose from $720 to $2205. 0276U fell from $2448 to $45. 0364U fell from $2007 to $337. 0382U rose from $51 to $962. 0485U rose from $3649 to $5250. 0489U rose from $1153 to $2448. 0543U fell from $2989 to $1337. Chat GPT rewrites...
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The highest-priced test remained unchanged: Caris Life Sciences’ MI Cancer Seek–NGS Analysis (0211U) stayed at $8,455.
Several tests received substantial increases. Silbiotech’s BBDRisk Dx (0067U) rose from $1,897 to $3,330. Grifols Diagnostic Solutions’ BLOODchip ID CORE XT (0084U) more than tripled, from $720 to $2,205. Mayo Clinic Laboratories’ Phenylalanine and Tyrosine, Self-Collect, Blood Spot test (0382U) increased nearly nineteen-fold, from $51 to $962. Caris Life Sciences’ liquid-biopsy test, Caris Assure (0485U), rose from $3,649 to $5,250, while BillionToOne’s UNITY Fetal Risk Screen (0489U) increased from $1,153 to $2,448.
Other tests experienced dramatic reductions. Versiti Diagnostic Laboratories’ Inherited Thrombocytopenia Panel (0276U) fell from $2,448 to just $45. Adaptive Biotechnologies’ clonoSEQ Assay (0364U) dropped from $2,007 to $337. Illumina’s TruSight Oncology Comprehensive test (0543U) declined from $2,989 to $1,337. Click to enlarge.
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CMS takes comments on the data for 30 days, but doesn't have authority to do other than calculate a median and use it, so the comment period is not very stimulating.
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PAMA is brutal on kitted molecular tests
Once again, PAMA Is brutal on kitted molecular tests. Nanostring got 510K clearance for Prosigna, essentially "Oncotype in a Box," a test which won crosswalk to Oncotype $3443 when Prosigna was new. However, it got a brutally low price of $900 in the 2017 cycle of PAMA, resulting in year-by-year cuts. (The code was deleted in the 9/2026 AMA CPT meeting.) [*]
The same story plays out for 0543U, the Illumina Trusight Oncology Comprehensive test. It won a crosswalk price of $2989 (basically the same as 81455), but gets a PAMA price of only $1337. Apparently labs responsible for billing payers and then reporting PAMA prices did a poor job of it, to the detriment of Illumina. CMS doesn't post data on 0543U reported prices, indicating there were fewer than 10 of them in 1H2025.
You can't help seeing the parallel between Prosigna ("oncotype in a box") and Illumina Trusight ("FMI in a box.") Both get chopped in half and tossed out the window via PAMA.
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The Prosigna story is messy because it was priced as Admin-MAAA 0008M then upgraded to Cat I 81520, but the results are as stated here. $3443 to $900.