Pathology clinical consultation for clinical problem, 5-20 minutes
Medicare pricing data for 592 providers across 36 states
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 clinical consultation for clinical problem, 5-20 minutes (HCPCS code 80503) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $22.97, but hospitals typically charge $86.11 — a 3.7x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $22.97, your out-of-pocket cost would be approximately $4.59. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 3.7x more than what Medicare allows for this procedure. Medicare actually pays $17.38 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Virginia | $29 | $101 | 15 | 1,294 | +27.3% |
| New Jersey | $27 | $42 | 9 | 591 | +16.3% |
| Massachusetts | $27 | $69 | 24 | 780 | +16.0% |
| Washington | $27 | $65 | 10 | 974 | +15.8% |
| Maryland | $26 | $69 | 9 | 283 | +13.5% |
| Oregon | $26 | $53 | 1 | 341 | +13.1% |
| California | $25 | $92 | 51 | 401 | +7.2% |
| South Dakota | $24 | $83 | 10 | 109 | +4.7% |
| Idaho | $24 | $45 | 6 | 82 | +4.5% |
| Indiana | $24 | $112 | 16 | 194 | +4.0% |
| Colorado | $24 | $131 | 11 | 185 | +3.4% |
| New Hampshire | $24 | $74 | 2 | 22 | +2.4% |
| Oklahoma | $23 | $50 | 20 | 2,252 | +1.9% |
| New York | $23 | $108 | 38 | 1,315 | +0.3% |
| Minnesota | $23 | $119 | 23 | 321 | -1.3% |
| Nebraska | $23 | $92 | 7 | 293 | -1.3% |
| Kansas | $23 | $62 | 5 | 67 | -1.8% |
| Ohio | $22 | $64 | 32 | 386 | -2.2% |
| Michigan | $22 | $136 | 33 | 2,117 | -3.0% |
| Pennsylvania | $22 | $103 | 35 | 354 | -4.1% |
| Illinois | $22 | $64 | 14 | 275 | -4.4% |
| Florida | $22 | $79 | 32 | 971 | -5.0% |
| Missouri | $22 | $64 | 10 | 139 | -5.7% |
| Louisiana | $21 | $83 | 7 | 801 | -6.8% |
| Texas | $21 | $98 | 82 | 1,814 | -7.1% |
| Arizona | $21 | $56 | 7 | 164 | -7.4% |
| South Carolina | $21 | $101 | 3 | 287 | -7.4% |
| Puerto Rico | $21 | $39 | 1 | 20 | -7.8% |
| North Carolina | $21 | $50 | 9 | 998 | -7.9% |
| Georgia | $21 | $56 | 4 | 36 | -8.6% |
| Maine | $21 | $96 | 1 | 32 | -9.4% |
| Mississippi | $21 | $86 | 6 | 458 | -9.4% |
| Iowa | $21 | $91 | 13 | 548 | -10.0% |
| Tennessee | $21 | $93 | 12 | 3,226 | -10.0% |
| Alabama | $21 | $58 | 8 | 150 | -10.8% |
| West Virginia | $20 | $87 | 6 | 33 | -12.4% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber