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Pathologist Consultation On A Complex Lab Result

New York rates for HCPCS 80504

This is a pathologist's professional service reviewing an unusual, unexpected, or hard-to-interpret laboratory result and providing expert clinical guidance directly to the treating doctor about what it likely means and how it might affect the patient's care. It is a consultation about test results and their interpretation, not the hands-on examination of a tissue sample under a microscope. It typically happens behind the scenes, without direct involvement of the patient.

Rates data updated July 2026.

How much does Pathologist Consultation On A Complex Lab Result cost?

$39.81

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $39.81 for this service. The price depends on where it is billed: about $39.81 from a physician practice, and about $41.69 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$39.81$30.20 to $53.70
FacilityA hospital or hospital-owned outpatient department$41.69$39.81 to $44.67

How much rates vary

Facilitymedian $42 · 10th to 90th $38 to $45Professionalmedian $40 · 10th to 90th $21 to $93
$20$50$100$200facility $42professional $40

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$39.81
Typical High
$44.67
Aetna
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$39.81
Typical High
$69.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$21.38
Typical High
$123.03
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$67.61
Typical High
$67.61
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$67.61
Typical High
$74.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
Cigna
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$58.88
Typical High
$144.54
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$40.74
Typical High
$72.44
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$46.77
Typical High
$91.20
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$52.48
Typical High
$109.65
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$43.65
Typical High
$57.54
United
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$42.66
Typical High
$97.72
Univera
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$48.98
Typical High
$91.20

Where New York sits

The same service costs 3.0 times more in Minnesota than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

New York· 44th of 51

$39.81

MN $102DE $33.88

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.