88369

Microscopic genetic analysis of tissue, manual, each additional procedure

Medicare pricing data for 154 providers across 36 states

🤖AI Overview

Prices vary significantly by location — from $31 in Washington to $136 in New York. Where you get this procedure matters more than almost any other factor. 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

Microscopic genetic analysis of tissue, manual, each additional procedure (HCPCS code 88369) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $101.30, but hospitals typically charge $320.75 — a 3.2x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$20.26

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $101.30, your out-of-pocket cost would be approximately $20.26. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$101.30
Average Hospital Charge
$320.75
Markup Ratio
3.2x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$320.75
Medicare Allowed$101.30
Medicare Payment$80.76

Hospitals charge 3.2x more than what Medicare allows for this procedure. Medicare actually pays $80.76 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$136$402102,401+34.2%
Connecticut$129$43141,127+27.8%
Nevada$121$166187+19.8%
Illinois$118$250978+16.0%
New Jersey$113$5372190+11.9%
Arizona$112$245916+10.9%
Kentucky$102$205114+1.0%
Virginia$85$240589-15.8%
Texas$76$221191,434-24.9%
California$70$250261,086-30.7%
South Carolina$69$478229-32.1%
Wisconsin$65$205518-35.6%
Georgia$42$106289-58.4%
Michigan$34$1689123-66.5%
Maryland$34$322251-66.6%
Utah$34$1681157-66.8%
Oregon$33$28624304-67.0%
Massachusetts$33$17420143-67.4%
New Mexico$33$302237-67.5%
Rhode Island$33$971142-67.5%
Pennsylvania$33$247922-67.8%
Indiana$33$167655-67.8%
Florida$32$167936-68.1%
Tennessee$32$14014434-68.1%
Louisiana$32$74422-68.2%
Minnesota$32$3509358-68.4%
Missouri$32$20633450-68.7%
Hawaii$32$320126-68.8%
Vermont$32$170123-68.9%
North Carolina$31$1091040-69.0%
Ohio$31$177525-69.0%
Kansas$31$17124647-69.0%
Idaho$31$80425-69.1%
Iowa$31$91619-69.2%
Nebraska$31$981029-69.3%
Washington$31$393314-69.6%

⚠️ 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