88304

Pathology examination of tissue using a microscope, moderately low complexity

Medicare pricing data for 14,885 providers across 52 states

🤖AI Overview

This procedure has a 5.3x markup — hospitals charge $110.43 but Medicare allows only $20.96. Uninsured patients may face bills 5.3 times higher than what insurance negotiates. Prices vary significantly by location — from $12 in Rhode Island to $30 in Arkansas. 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

Pathology examination of tissue using a microscope, moderately low complexity (HCPCS code 88304) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $20.96, but hospitals typically charge $110.43 — a 5.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$4.19

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $20.96, your out-of-pocket cost would be approximately $4.19. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$20.96
Average Hospital Charge
$110.43
Markup Ratio
5.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$110.43
Medicare Allowed$20.96
Medicare Payment$16.00

Hospitals charge 5.3x more than what Medicare allows for this procedure. Medicare actually pays $16.00 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Arkansas$30$7516822,491+42.7%
Puerto Rico$30$54701,259+41.2%
Wyoming$28$14421732+31.8%
Hawaii$28$82712,699+31.2%
New York$25$10387351,646+20.1%
Georgia$24$10734022,052+16.1%
California$24$1101,63578,118+16.1%
Florida$24$11185972,127+15.0%
Arizona$24$7930915,831+14.1%
Connecticut$23$1252097,938+11.5%
Idaho$23$77492,116+11.3%
Texas$23$1431,13765,806+11.0%
Alabama$22$11718014,420+5.6%
Nevada$22$144974,927+3.9%
Delaware$22$91422,808+3.2%
Washington$21$9041715,011+2.4%
Wisconsin$21$25734516,721+0.2%
Maryland$21$9929517,417-1.3%
Massachusetts$21$10851930,838-1.7%
North Carolina$20$9639822,138-3.6%
New Hampshire$20$182704,308-4.7%
Colorado$20$1042269,983-5.8%
Oregon$20$972216,784-6.4%
Virginia$19$10030714,835-7.3%
Tennessee$19$9143425,266-8.6%
Oklahoma$19$741158,506-8.7%
Pennsylvania$19$8860336,061-9.0%
New Jersey$19$11731321,074-9.1%
Utah$18$831693,934-12.9%
District of Columbia$18$80502,202-13.4%
South Carolina$18$13121816,009-14.1%
Ohio$18$11159329,737-16.4%
Kansas$17$971539,512-16.7%
Illinois$17$13260132,607-19.3%
Indiana$17$11822913,042-20.8%
Michigan$17$9442317,543-20.8%
West Virginia$16$93813,740-21.7%
Minnesota$16$9054411,369-22.5%
Missouri$16$12230514,764-23.5%
New Mexico$16$106703,408-24.0%
Alaska$16$17018970-24.5%
Kentucky$15$981789,496-26.4%
Montana$15$64392,814-26.4%
Mississippi$15$1051037,968-28.0%
Iowa$15$1221458,400-29.2%
Louisiana$15$8921713,146-29.2%
Nebraska$15$1051216,429-29.6%
South Dakota$14$53823,500-34.0%
Maine$14$55752,730-34.5%
North Dakota$13$69483,727-37.2%
Vermont$13$82401,480-38.2%
Rhode Island$12$114521,702-42.3%

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

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