88120

Cell examination of urine, manual

Medicare pricing data for 577 providers across 31 states

🤖AI Overview

Prices vary significantly by location — from $56 in Wisconsin to $597 in District of Columbia. Where you get this procedure matters more than almost any other factor. 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

Cell examination of urine, manual (HCPCS code 88120) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $463.80, but hospitals typically charge $1,260 — a 2.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$92.76

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $463.80, your out-of-pocket cost would be approximately $92.76. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$463.80
Average Hospital Charge
$1,260
Markup Ratio
2.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,260.41
Medicare Allowed$463.80
Medicare Payment$367.73

Hospitals charge 2.7x more than what Medicare allows for this procedure. Medicare actually pays $367.73 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$597$1,3815933+28.8%
Nevada$594$1,032148+28.2%
Maryland$567$1,846181,433+22.2%
New York$559$2,000479,343+20.6%
Illinois$540$1,079271,915+16.4%
Michigan$532$1,5598239+14.6%
Tennessee$527$896172,467+13.7%
Texas$519$1,072424,374+11.9%
California$498$1,472465,347+7.3%
Utah$488$1,468117+5.1%
Connecticut$471$774122,316+1.6%
Missouri$454$1,0019406-2.1%
Florida$444$1,008313,777-4.3%
Virginia$443$1,24710891-4.5%
New Jersey$443$1,1313314,254-4.6%
Oklahoma$437$79821,942-5.7%
Massachusetts$409$1,000495,111-11.8%
Arizona$384$860241,988-17.2%
Minnesota$319$1,06248274-31.2%
Kansas$281$6101117-39.4%
South Carolina$251$430272-45.8%
Pennsylvania$204$1,726252,236-56.1%
Louisiana$200$7591083-56.8%
Ohio$126$70029469-72.8%
Delaware$102$7717166-78.0%
Colorado$70$174388-85.0%
North Carolina$70$2041169-85.0%
Rhode Island$59$135234-87.4%
Washington$57$801435-87.7%
Iowa$56$228323-87.8%
Wisconsin$56$182256-88.0%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber