Pathology clinical consultation for complex clinical problem, 41-60 minutes
Medicare pricing data for 20 providers across 17 states
This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Pathology clinical consultation for complex clinical problem, 41-60 minutes (HCPCS code 80505) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $96.58, but hospitals typically charge $152.16 — a 1.6x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $96.58, your out-of-pocket cost would be approximately $19.32. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 1.6x more than what Medicare allows for this procedure. Medicare actually pays $71.39 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| New York | $109 | $217 | 2 | 12 | +12.7% |
| Colorado | $100 | $152 | 1 | 428 | +4.0% |
| Texas | $96 | $152 | 3 | 5,755 | -0.3% |
| Massachusetts | $94 | $319 | 5 | 55 | -2.2% |
| California | $94 | $432 | 5 | 60 | -2.5% |
| Maryland | $94 | $156 | 8 | 81 | -2.9% |
| Illinois | $94 | $461 | 3 | 23 | -3.0% |
| Michigan | $91 | $462 | 9 | 18 | -5.6% |
| Oklahoma | $91 | $105 | 1 | 22 | -5.7% |
| Arizona | $88 | $217 | 4 | 21 | -8.5% |
| Louisiana | $88 | $190 | 2 | 13 | -9.0% |
| Minnesota | $88 | $493 | 7 | 17 | -9.3% |
| Missouri | $86 | $244 | 2 | 40 | -11.3% |
| Pennsylvania | $85 | $239 | 6 | 11 | -11.7% |
| Washington | $84 | $230 | 1 | 52 | -12.6% |
| Nebraska | $84 | $234 | 3 | 26 | -13.1% |
| Arkansas | $83 | $139 | 2 | 51 | -14.2% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber