88307

Pathology examination of tissue using a microscope, moderately high complexity

Code 88307. Medicare covered 903,970 of these. Here is what providers billed and what Medicare allowed, state by state.

$366.05Billed, national avg
$85.94Medicare allowed
4.3xBilled vs allowed
4.4xHighest vs lowest state

Providers in New Hampshire billed the most for this, at $665.89. In Puerto Rico the average was $149.98. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
New Hampshire$665.89$78.868.4x5,221
Wisconsin$583.64$79.207.4x17,020
Alaska$567.75$105.715.4x1,688
Rhode Island$464.38$80.505.8x2,966
Wyoming$461.07$84.455.5x346
West Virginia$445.91$75.885.9x4,218
New York$434.47$90.034.8x60,967
Foreign Country$427.01$80.095.3x507
Iowa$410.75$84.174.9x11,472
Texas$410.20$83.394.9x62,407
Connecticut$394.31$87.854.5x8,567
Illinois$391.43$82.154.8x36,968
Ohio$390.59$77.415.0x33,103
Kansas$389.22$82.834.7x11,784
New Jersey$386.25$96.124.0x22,284
Florida$382.41$84.764.5x62,816
Nevada$381.00$81.784.7x4,467
California$380.90$100.683.8x88,447
Minnesota$376.85$82.384.6x17,288
Vermont$373.47$76.874.9x1,710
Nebraska$363.92$96.683.8x7,833
Oregon$361.08$90.204.0x8,070
Virginia$359.50$84.914.2x24,266
Indiana$359.29$83.964.3x17,717
Armed Forces Europe$358.00$85.034.2x34
Colorado$355.25$95.313.7x13,403
Massachusetts$352.45$83.924.2x39,891
South Carolina$350.50$77.144.5x17,744
New Mexico$347.86$85.894.0x3,452
Pennsylvania$343.36$79.004.3x44,311
Missouri$343.08$78.254.4x19,924
Maryland$341.72$92.203.7x22,201
Georgia$335.42$94.713.5x21,645
Tennessee$328.92$87.273.8x22,952
Kentucky$326.63$78.464.2x12,445
North Carolina$322.89$83.103.9x24,893
Alabama$310.35$80.673.8x11,395
Michigan$307.16$78.563.9x21,975
Utah$296.49$81.423.6x7,630
Washington$295.16$86.893.4x21,549
Mississippi$292.49$77.243.8x7,558
Louisiana$286.37$78.703.6x10,952
North Dakota$285.19$81.033.5x2,673
Oklahoma$283.96$81.453.5x9,756
South Dakota$282.62$77.453.6x4,661
Armed Forces Pacific$272.67$77.873.5x45
District of Columbia$269.60$84.443.2x4,264
Delaware$261.07$80.243.3x3,956
Arkansas$256.89$95.892.7x8,807
Arizona$252.54$85.033.0x20,812
Montana$248.70$79.593.1x3,476
Hawaii$247.79$89.642.8x2,108
Maine$243.54$77.573.1x3,959
Idaho$233.93$80.412.9x2,593
Guam$210.90$83.382.5x52
Puerto Rico$149.98$93.171.6x711

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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