Avalon 2025 Lab Trend Report: Genetic Testing Soars as Routine Testing Stabilizes

Surging demand for biomarkers and genetic diagnostics spotlights cost, access, and innovation challenges for health plans

TAMPA, Fla., June 24, 2025 /PRNewswire/ -- A sharp rise in genetic and biomarker testing is transforming the lab testing landscape, even as routine diagnostics stabilize, according to the newly released 2025 Lab Trend Report from Avalon Healthcare Solutions.

Now in its fifth year, this sentinel industry report leverages data from 18 million health plan members, a subset of Avalon's 44+ million managed lives, to deliver critical insights for health plans navigating the intersection of rising diagnostic demand, cost variability, and clinical innovation.

"Lab testing is the most utilized medical benefit in healthcare, influencing the majority of clinical decisions—yet it remains one of the most undermanaged," said Bill Kerr, MD, CEO of Avalon Healthcare Solutions. "To fully realize its power to improve outcomes and reduce costs, we must modernize how diagnostics are selected, delivered, and paid for. Our report offers health plans the data-driven insights needed to close that gap and lead in the shift toward smarter, value-based care."

Below are some highlights of the report:

Pricing discrepancies

While the use of testing grows, so do the discrepancies in pricing related to where the tests are performed. The Lab Trend Report compared the prices of a basic and comprehensive metabolic panel (CPT 80053) by location and found that a test that cost $8.51 at an independent lab was $12.04 at a physician's office and $48.45 at a hospital outpatient lab, nearly six times more than at the independent lab. And it's not just one test — hospital outpatient labs charged the most for the top 10 procedure codes by test volume.

Routine testing

Routine testing, which accounts for approximately 90% of testing by volume, cost health plans that contract with Avalon an average of $192 PMPY last year, a 2% increase from 2023. General routine testing increased 4% to $183 PMPY while COVID testing declined 27% to $9 PMPY. The testing volume was down, largely due to a decline in COVID testing.

A matched increase in utilization and spend (both 2%) suggests more testing was the cause of the increase rather than a change in the price mix of testing. Avalon's data-driven management solutions control costs and eliminate waste and abuse, while ensuring members receive the appropriate tests.

From 2020 to 2024, the five-year period during which Avalon produced the Lab Trend Report, overall spend on routine testing for Avalon clients increased only 1% compared to an industry trend of 2-5% CAGR. These findings demonstrate Avalon's effective program management and controlled spend. The increase in general non-COVID spend during that time was 16%, which is consistent with the aging population, chronic disease, and a rebound from reduced testing during the pandemic.

The challenges in routine testing management include overutilization and underutilization, the need for disease-specific care models, discrepancies in place of service, and waste, and abuse.

Genetic testing

The average health plan spend on genetic testing in 2024 was $14.80 per member per year (PMPY), an increase of 10% from 2023. The utilization of genetic testing increased by 10%. This increased spending and utilization are due to both the rising costs of genetic tests and the increasing use of genetic testing. Though only 10% of testing by volume, genetic testing accounts for 30% of payer spend.

Between 2020 and 2024, overall spending on genetic testing increased by 66%, while overall utilization rose by 56%. The spend for Avalon clients was significantly less than the predicted 75% industry increase, a result of effective program management and controlled spend and utilization for genetic testing.

There are over 175,000 genetic tests in the U.S., but only about 500 CPT codes to cover them. The challenges to genetic test management continue to be insufficient coding to identify and differentiate tests (40,000 tests under CPT 81479), quality control (including a strong concentration of labs running genetic tests and a dearth of trained lab professionals), pricing, and determining the clinical utility of the tests.

Emerging Trends- Biomarker testing

The report, the fifth issued by Avalon, reviews recent lab data and market dynamics to identify significant emerging trends for healthcare executives. One of the highlights is the growing use of biomarker testing for risk/probability, diagnosis, prognosis, prediction, monitoring, and safety across a variety of diseases and conditions.

Among the most promising biomarker tests:

• Multi-cancer early detection (MCED) tests, which identify signals in the blood released by cancer cells
• Polygenetic risk score (PRS) tests which estimate an individual's risk for common diseases
• Alzheimer's disease (AD) tests, which measure blood amyloid levels in symptomatic patients

Every day, we partner with health plans to reduce diagnostic waste, eliminate uncertainty, and ensure that testing drives smarter, more effective care," said Kristie Ressler, DO, Chief Medical Officer at Avalon Healthcare Solutions. "As diagnostics become more sophisticated, payers need strategies that are just as advanced: grounded in evidence, driven by data, and built to deliver value."

To download a copy of the Avalon 2025 Lab Trend Report, click here.

About Avalon Healthcare Solutions

Avalon is the leader in diagnostic intelligence, helping health plans and providers unlock the full value of diagnostic science. We simplify complex diagnostics, accelerate the adoption of proven innovations, and optimize diagnostic investments. Through our proprietary Diagnostic Insights Platform, we integrate evidence-based policies, curated lab networks, and real-time insights to improve health outcomes, reduce costs, and enable personalized care at scale.

With unmatched diagnostic focus, deep scientific expertise, and a proven performance-based model, we support over 30 health plans and 44 million members nationwide—delivering smarter testing, better care, and measurable value. For more information about Avalon, visit www.avalonhcs.com.

Media Contacts:
Michele Norton MS, RN
SVP Product Marketing, Avalon Healthcare Solutions
Michele.norton@avalonhcs.com

Janet Mordecai
Amendola Communications for Avalon Healthcare Solutions
jmordecai@acmarketingpr.com

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SOURCE Avalon Healthcare Solutions