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Pennsylvania rates for HCPCS 80504

Pathology clinical consultation; for a moderately complex clinical problem, with review of patient's history and medical records and moderate level of medical decision making. When using time for code selection, 21-40 minutes of total time is spent on the date of the consultation.

Facilitymedian $76 · 10th–90th $76–$5250%20%40%90th$76Professionalmedian $41 · 10th–90th $30–$890%10%20%10th90th$41$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $40.74 / $89.13
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $48.98
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $53.70 / $91.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $34.67 / $75.86
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $51.29 / $77.62
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $57.54 / $109.65
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $48.98 / $50.12
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $40.74 / $69.18
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $89.13 / $95.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $53.70 / $117.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $524.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $48.98 / $81.28