Pathology reimbursement rates by service line
Compare national pathology reimbursement benchmarks calculated from price transparency data. Reference benchmarks cover 88305, 88307 and 88342 across Aetna, Anthem, Cigna and United. Reporting periods: Jun–Jul 2026.
Rate Explorer
Compare national pathology rates by payer
Review surgical pathology and immunohistochemistry benchmarks while keeping laboratory disciplines and billing components separate.
Aetna state variation for 88305
National 88305 rate distribution
Each marker shows the national median published rate across billing entities for that payer.
National 88305 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Jun–Jul 2026 | 16,844 | $41.78 | $50.59 | |||
| Cigna | Jun–Jul 2026 | 19,288 | $53.66 | $64.30 | |||
| United | Jun–Jul 2026 | 18,322 | $51.14 | $65.28 | |||
| Anthem | Jun–Jul 2026 | 20,840 | $82.33 | $89.31 |
- Source
- Negotiated or fee-schedule amounts published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for surgical pathology, gross and microscopic examination (88305).
- Method
- Eligible rates are grouped by payer and billing entity so the benchmarks use a consistent service and billing basis.
The state map uses one consistent Aetna reference series; it does not average already-aggregated payer values. The service-line table keeps unlike codes, settings, and billing units in separate comparisons.
Confirm coverage for your codes, payers and markets.
How do specific pathology providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Pathology provider rates by payer (CPT 88305)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| JENNIE EDMUNDSON MEMORIAL HOSPITALNPI 1265810287 · Tax ID 420680355 | NE | 143 | $23 | -$18.78 | Below P25 |
| DERMATOLOGY ASSOCIATES INCNPI 1457359945 · Tax ID 341788105 | MI | 16 | $28.01 | -$13.77 | Below P25 |
| COOPERATIVE HEALTHCARE SERVICES INCNPI 1760440481 · Tax ID 010594994 | FL | 439 | $31.29 | -$10.50 | Below P25 |
| DIAGNOSTIC RADIOLOGISTS, P.C.NPI 1346654027 · Tax ID 930604377 | MS | 63 | $36.32 | -$5.46 | P25 to median |
| YORK HOSPITALNPI 1598736647 · Tax ID 231352222 | PA | 2,977 | Median to P75 | ||
| UC REGENTS DEPARTMENT OF RADIATION ONCOLOGYNPI 1558463653 · Tax ID 954547089 | CA | 1,539 | Above P75 |
Choose one state to replace the mixed-state examples with payer-specific provider rates for available preview codes.
No trial or data preparation required.Which providers have the highest claim volume in the pathology market?
Provider organizations with the highest combined 2024 Medicare and Medicaid claim volume in the pathology market.
- 1CAAffiliated Pathologists Medical Group INCNPI 1730119553Medicare 181,363Medicaid 95,447276,810 total
- 2CAChlamg Pathology LPNPI 1316241102Medicare 13,880Medicaid 158,323172,203 total
- 3CAUCI Department of PathologyNPI 1558311811Medicare 8,285Medicaid 130,736139,021 total
- 4CABoris Shoplov MD Pathology MedicalNPI 1972080752Medicare 112,704Medicaid 15,864128,568 total
- 5CAAnalytic Pathology Medical Group INC.NPI 1568431088Medicare 55,837Medicaid 66,195122,032 total
- 6CAPathology Med Group Of RiversideNPI 1417016833Medicare 70,606Medicaid 20,46491,070 total
- 7CALong Beach Memorial Pathology Medical Group INC.NPI 1942257191Medicare 47,190Medicaid 43,68390,873 total
- 8FLIntegrated Regional Laboratories Pathology Services LLCNPI 1942526298Medicare 20,140Medicaid 68,67788,817 total
- 9CARedding PathologistsNPI 1093712689Medicare 84Medicaid 84,80784,891 total
- 10CAMendocino Laboratory AssociatesNPI 1902538580Medicare 73Medicaid 79,15879,231 total
- 11CAStockton Pathology Medical GroupNPI 1871522680Medicare 77,351Medicaid 22777,578 total
- 12CAYosemite Pathology Medical Group INCNPI 1598760985Medicare 72,679Medicaid 63273,311 total
- 13CADelta Medical Group Of Pathologists INCNPI 1518192079Medicare 65,234Medicaid 7,47872,712 total
- 14FLRuffolo Hooper and Associates M.D. P.A.NPI 1790732360Medicare 18,933Medicaid 49,97668,909 total
- 15CAMission Pathology Consultants INCNPI 1356409379Medicare 56,528Medicaid 9,33865,866 total
- 16FLComprehensive Pathology Associates P.A.NPI 1871567289Medicare 27,702Medicaid 33,00160,703 total
- 17NJEnglewood Pathologists PANPI 1053366054Medicare 59,861Medicaid 7759,938 total
- 18CAAw Pathology Medical Group INCNPI 1972534147Medicare 43,730Medicaid 11,65455,384 total
- 19CASan Gabriel Valley Consulting PathologisNPI 1255390837Medicare 44,793Medicaid 4,14648,939 total
- 20CAWhittier Pathology Medical GroupNPI 1548396831Medicare 32,741Medicaid 16,10248,843 total
How reimbursement changes across pathology and laboratory services
Keep surgical pathology, stains, immunohistochemistry, hematology, chemistry, coagulation, and microbiology services in their appropriate billing context.
| Service line / billing code | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
$ per service · 5 codes | ||||
88305Surgical pathology, gross and microscopic examination | $50.59 | $64.30 | $65.28 | $89.31 |
88307Higher-complexity surgical pathology examination | $110.85 | $136.68 | $142.12 | $185.03 |
88313Special stains, group 2 | $16.23 | $19.96 | $20.58 | $25.75 |
88341Immunohistochemistry, each additional antibody | $34.32 | $43.58 | $46.94 | $55.27 |
88342Immunohistochemistry, first antibody | $49.27 | $62.25 | $61.30 | $81.51 |
$ per service · 4 codes | ||||
85025Complete blood count with automated differential | $10.68 | $17.26 | $9.70 | $17.21 |
85027Complete blood count without differential | $8.95 | $14.58 | $8.03 | $14.36 |
85610Prothrombin time | $5.79 | $9.51 | $6.20 | $9.09 |
85730Partial thromboplastin time | $8.21 | $13.57 | $7.50 | $13.11 |
$ per service · 9 codes | ||||
81001Automated urinalysis with microscopy | $4.44 | $6.78 | $4.69 | $7.11 |
81003Automated urinalysis without microscopy | $3.13 | $4.89 | $3.32 | $5.01 |
82947Quantitative blood glucose assay | $5.40 | $8.79 | $5.79 | $8.90 |
83605Lactic acid assay | $14.42 | $22.90 | $14.15 | $23.90 |
83690Lipase assay | $9.44 | $14.80 | $8.59 | $15.10 |
83735Magnesium assay | $9.35 | $13.56 | $8.41 | $14.74 |
84100Phosphorus assay | $6.63 | $10.07 | $5.89 | $10.36 |
84443Thyroid-stimulating hormone assay | $22.38 | $35.86 | $20.93 | $36.79 |
84484Quantitative troponin assay | $15.41 | $23.01 | $15.92 | $25.53 |
$ per service · 2 codes | ||||
86900Serologic ABO blood typing | $4.19 | $6.54 | $3.76 | $6.63 |
87040Bacterial blood culture | $13.96 | $21.70 | $12.92 | $22.18 |
Tell us the services, payers, states, and networks you need. We'll confirm available coverage and scope the comparison on a 20-minute call.
Book a 20-min scoping call No trial or data preparation required.How to read these pathology rates
Benchmarks calculated by PayerPrice from health plan price transparency files. CMS price transparency requirements.
- Published rates, not paymentsThese figures summarize negotiated rates reported by health plans. They are not claim payments, patient prices or a provider's verified contract.
- Average vs. medianThe average combines eligible billing-entity rates; the median is the middle rate. A large gap between them can signal that high or low rates are pulling the average.
- What a provider row meansA billing entity may be a clinician, practice, facility or health system. A named row does not always represent one individual provider.
- Compare like for likeMatch the code, billing component, setting, payment unit, network and reporting period. Facility, drug and other service payments may be separate.
Calculation details and specialty-specific notes
Use this methodology to understand what each published rate represents and which billing details must match before comparing pathology and laboratory services.
- Rate source
- Each value is a negotiated pathology or laboratory rate published in a payer machine-readable file, not a claim, charge, or utilization estimate.
- Rate calculation
- National figures use eligible published rate records across the country; state views use records tied to the selected state. Averages are not weighted by specimen or test volume. The calculation targets the lowest and highest 2% of entity rates for removal, rounded down to whole entities. Tied boundary values stay together, so fewer rates may be removed. A payer, code and geography cohort is published only when at least 10 billing entities remain after trimming. A missing benchmark does not mean the rate is zero.
- Provider entity
- Named examples use payer-file NPI and TIN records. An entity may represent a laboratory, pathology group, health system, or another billing organization. Each NPI and TIN combination contributes one representative rate: its most frequent normalized value. When multiple values are equally frequent, those values are averaged.
- Comparable rates
- Match the exact code, specimen or test method, professional, technical, or global component, modifier, payment unit, payer product, and network. Contract rules may bundle related services. Benchmarks keep the payer, service code, geography, reporting period and billing unit separate. Different services or payment units are not blended into one rate.
Compare Pathology rates in your market
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Explore pathology rates by state
Choose a state to compare payer reference averages for common services.
How to interpret pathology rates
How to interpret the selected market and payer-published rates.
Which pathology services are represented?
The report includes surgical pathology, special stains, immunohistochemistry, and a selected set of high-volume laboratory services.
Why do professional and technical components matter?
Pathology services may be paid for physician interpretation, technical processing, or both. Those components should not be blended without checking modifier context.
Can all laboratory tests be compared using one unit?
No. Each CPT code represents a distinct test or service and should be interpreted using its own billed unit.
Which billing details change a pathology rate comparison?
Confirm the exact code, specimen or test method, professional, technical, or global component, modifier, payment unit, payer product, and network.
How are named pathology providers selected?
Provider examples are sampled from different points in the selected payer's rate range. An entity may be a laboratory, pathology group, health system, or another billing organization. The national overview includes public provider samples; state provider-level comparisons require a free state preview.