88309

Pathology examination of tissue using a microscope, high complexity

Medicare pricing data for 8,972 providers across 52 states

🤖AI Overview

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, high complexity (HCPCS code 88309) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $145.98, but hospitals typically charge $551.41 — a 3.8x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$29.20

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $145.98, your out-of-pocket cost would be approximately $29.20. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$145.98
Average Hospital Charge
$551.41
Markup Ratio
3.8x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$551.41
Medicare Allowed$145.98
Medicare Payment$115.69

Hospitals charge 3.8x more than what Medicare allows for this procedure. Medicare actually pays $115.69 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Missouri$216$4901994,415+48.0%
Alaska$188$1,03314221+28.6%
New Mexico$174$46647803+19.1%
California$155$62685612,345+6.5%
New Jersey$152$5771902,578+3.9%
District of Columbia$151$44638421+3.7%
New York$151$6605928,572+3.6%
Maryland$151$4821963,586+3.3%
Massachusetts$150$5733525,298+2.7%
Connecticut$148$5761261,199+1.4%
Washington$148$4411953,004+1.3%
Wyoming$147$5711241+0.8%
Hawaii$145$36230291-0.6%
Oregon$145$610991,153-0.7%
Rhode Island$145$62235346-0.8%
Colorado$144$4991381,711-1.5%
Virginia$143$5241823,144-2.0%
Delaware$143$47723459-2.3%
Illinois$143$5934024,964-2.3%
Pennsylvania$142$5324486,501-2.4%
North Dakota$141$44430321-3.5%
Minnesota$141$5802612,885-3.5%
Florida$141$5505348,510-3.6%
Texas$141$5766898,208-3.7%
Montana$140$39627598-3.9%
South Dakota$140$48239798-4.0%
Iowa$140$624931,850-4.1%
New Hampshire$140$1,12945601-4.2%
Vermont$139$70031247-4.6%
Maine$139$42445436-4.6%
Wisconsin$139$9562142,406-4.7%
Puerto Rico$139$1661771-4.7%
Arizona$139$4451582,894-4.8%
Kansas$138$5371031,733-5.2%
Michigan$138$5882872,904-5.2%
Utah$138$47578906-5.4%
Indiana$138$5451502,423-5.8%
North Carolina$137$4392383,433-5.9%
Nevada$137$57844539-5.9%
Ohio$137$4953964,963-6.0%
Georgia$137$5291902,824-6.0%
Arkansas$137$387831,476-6.2%
Nebraska$136$462601,058-6.6%
Louisiana$136$4501361,718-6.7%
Tennessee$136$4622383,729-6.7%
Alabama$136$4191181,696-6.8%
Oklahoma$136$418681,448-7.1%
South Carolina$136$4811232,574-7.1%
Kentucky$135$4841222,049-7.2%
Mississippi$135$433661,191-7.4%
Idaho$135$72421280-7.5%
West Virginia$134$68052686-7.9%

⚠️ 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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