88305

Pathology examination of tissue using a microscope, intermediate complexity

Medicare pricing data for 22,727 providers across 52 states

🤖AI Overview

This is one of the most commonly performed procedures in Medicare, with 18.3 million services annually. Even small pricing inefficiencies here affect millions of patients. 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, intermediate complexity (HCPCS code 88305) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $50.98, but hospitals typically charge $184.28 — a 3.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$10.20

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $50.98, your out-of-pocket cost would be approximately $10.20. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$50.98
Average Hospital Charge
$184.28
Markup Ratio
3.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$184.28
Medicare Allowed$50.98
Medicare Payment$38.77

Hospitals charge 3.6x more than what Medicare allows for this procedure. Medicare actually pays $38.77 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Puerto Rico$63$7211211,870+23.7%
New York$59$2151,4591,253,166+16.4%
Maryland$57$181429382,954+12.5%
Hawaii$56$1588841,311+10.6%
Georgia$56$179493577,512+10.4%
California$56$1792,4991,879,396+10.1%
Arizona$54$166429461,989+6.8%
Connecticut$54$198295215,380+6.7%
Wyoming$54$1783420,881+6.2%
Massachusetts$54$207691674,529+5.9%
Alabama$54$177279323,430+5.6%
Florida$54$1571,5191,990,796+5.3%
Texas$53$2221,6881,458,844+3.1%
New Jersey$52$204451514,459+2.1%
Pennsylvania$52$162790791,111+1.5%
North Carolina$51$155673568,008+0.8%
Idaho$51$1369347,765+0.7%
Nevada$51$217142122,989+0.6%
Delaware$51$1555743,242-0.4%
Washington$51$152610350,475-0.7%
District of Columbia$50$1286554,007-1.9%
Virginia$49$163434375,694-3.3%
Colorado$48$152349251,339-6.4%
Ohio$48$177908611,900-6.5%
Wisconsin$48$410513379,371-6.6%
Alaska$47$2953214,576-7.0%
Utah$47$152248101,910-8.7%
Illinois$46$217890640,509-10.1%
Tennessee$46$164672659,818-10.6%
Missouri$45$199440256,165-11.2%
Michigan$45$159603317,211-11.4%
Mississippi$45$188158113,522-11.6%
Oklahoma$45$137177130,228-12.5%
Oregon$44$157400174,294-13.0%
South Carolina$44$182359350,548-13.5%
Kansas$44$166216191,583-14.1%
New Hampshire$44$28187111,183-14.6%
Indiana$44$184345280,664-14.6%
Arkansas$43$113260262,065-15.0%
West Virginia$43$15212055,393-15.4%
New Mexico$43$1659757,902-15.5%
Kentucky$43$160230184,924-16.0%
Minnesota$43$1751,139258,336-16.3%
Nebraska$42$161164113,171-16.8%
Iowa$42$195197163,731-17.4%
Maine$42$13410059,342-18.4%
Montana$41$1275961,358-19.9%
North Dakota$38$1305968,397-24.9%
Vermont$38$1774632,294-25.2%
Rhode Island$38$16910034,853-25.7%
Louisiana$37$132311170,006-27.7%
South Dakota$37$12210579,724-28.3%

⚠️ 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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