How Much Does a Pathology Exam of Biopsy Tissue Cost in California?
Tissue exam by pathologist
$88Hospital outpatient total2026 Medicare, physician + facilityUnder 2026 Medicare rates, a pathology exam of biopsy tissue costs up to about $88 in total at a hospital outpatient department, counting both the physician and the facility (national rates). Outside a hospital, at an independent imaging center, lab or office, Medicare's full rate in California averages $79, from $75 in Chico to $92 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty).
- ✓Your ZIP's wage-adjusted hospital and surgery center rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
California Medicare physician rate (2026)
+12.6% vs nationalAverage of 29 localities. Office range $74.58–$92.44.
What the whole procedure costs
The office rate above is what an imaging center, lab or office is paid for the whole test. In a hospital, the facility bills its own fee and the physician bills only the reading. These are 2026 national Medicare amounts.
Medicare may pay the facility separately for this code or package it into another service on the same day, so treat the facility share as an upper bound. For a test like this the physician in a hospital bills only the reading (the professional component); outside a hospital one global fee covers the whole test, shown in the office rate above. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Your ZIP in California
A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
What pathology exam of biopsy tissue costs at hospitals near you
Everything above is a national average. The hospital you pick in California moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
For example 90001.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery center rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. In California the office and hospital physician lines for this CPT differ by $41.29.
National vs California
Where California ranks for this CPT
CPT 88305 by California locality
| Locality | Office |
|---|---|
| san jose-sunnyvale-santa clara (san benito cnty) | $92.44 |
| san jose-sunnyvale-santa clara (santa clara cnty) | $92.35 |
| san francisco-oakland-berkeley (marin cnty) | $90.58 |
| san francisco-oakland-berkeley (san francisco/san mateo/alameda/contra costa cnty) | $90.56 |
| napa | $85.69 |
| vallejo | $85.66 |
| santa rosa-petaluma | $80.84 |
| santa cruz-watsonville | $80.04 |
| san diego-chula vista-carlsbad | $79.41 |
| los angeles-long beach-anaheim (los angeles/orange cnty) | $79.17 |
| oxnard-thousand oaks-ventura | $78.78 |
| sacramento-roseville-folsom | $78.06 |
| santa maria-santa barbara | $78.00 |
| salinas | $77.76 |
| san luis obispo-paso robles | $76.51 |
| riverside-san bernardino-ontario | $74.81 |
| bakersfield | $74.67 |
| chico | $74.58 |
| el centro | $74.58 |
| fresno | $74.58 |
| hanford-corcoran | $74.58 |
| madera | $74.58 |
| merced | $74.58 |
| modesto | $74.58 |
| redding | $74.58 |
| stockton | $74.58 |
| visalia | $74.58 |
| yuba city | $74.58 |
| rest of california | $74.58 |
PE GPCI ranges from 1.096 to 1.442 in California. That index is why the same CPT is not one price statewide.
Pathology Exam of Biopsy Tissue and how California is priced
California is the most finely divided state in the Medicare fee schedule, with roughly thirty payment localities drawn around metropolitan statistical areas after CMS reformed the state's locality map. The San Francisco Bay Area carries some of the highest geographic adjustments in the nation, with San Francisco, San Jose, and the East Bay each priced separately, while Los Angeles, Orange County, San Diego, and Sacramento have their own localities at somewhat lower levels. Rural and inland counties fall into lower-cost localities, so the same procedure can carry meaningfully different Medicare-approved amounts within a single day's drive. No other state shows this much in-state variation on the fee schedule itself.
California's markets differ sharply: the Bay Area combines high wages with heavily consolidated hospital systems, Los Angeles offers enormous choice across a sprawling region, and the Central Valley and far north face genuine access shortages. Where you are treated within the state matters more here than almost anywhere else in the country. Academic medical centers in the Bay Area, Los Angeles, San Diego, and Sacramento handle much of the complex referral care.
This procedure: CPT 88305 covers a pathologist examining tissue from a biopsy or minor surgery under a microscope: a skin biopsy, a polyp removed during a colonoscopy, or a breast or prostate core, for example. The lab processes the tissue into stained glass slides, and a pathologist, often a dermatopathologist for skin samples, reads them and writes the diagnosis report. It is one of the most frequently billed pathology codes, and it is billed per specimen, so several biopsies from one procedure often produce several charges.
What Is Pathology Exam of Biopsy Tissue?
CPT 88305 covers a pathologist examining tissue from a biopsy or minor surgery under a microscope: a skin biopsy, a polyp removed during a colonoscopy, or a breast or prostate core, for example. The lab processes the tissue into stained glass slides, and a pathologist, often a dermatopathologist for skin samples, reads them and writes the diagnosis report. It is one of the most frequently billed pathology codes, and it is billed per specimen, so several biopsies from one procedure often produce several charges.
What Affects the Cost
- –Each separately submitted specimen is billed as its own unit, so three polyps sent in three containers can mean three charges.
- –Special stains or immunohistochemistry, used when the diagnosis is not clear on routine slides, are billed with additional codes such as 88312 or 88342.
- –An independent lab usually bills one global fee, while a hospital lab bills the tissue processing on its own claim and the pathologist bills the reading.
- –Out-of-network lab bills are a common surprise, because patients rarely choose the lab that receives their biopsy.
- –An outside second opinion on the slides is billed with separate consultation codes.
Questions to Ask Before Booking
- 1.Which lab will the tissue go to, and is it in my network?
- 2.How many specimens will be sent, and will each one be billed?
- 3.Will special stains or extra tests be run, and would you tell me first?
- 4.Is a dermatopathologist or other subspecialist reading the slides, and are they in network?
- 5.If I get a bill from a lab I did not choose, who do I contact to have it reprocessed?
Other featured procedures in California
Pathology Exam of Biopsy Tissue in other states
Pathology Exam of Biopsy Tissue in California: questions
Under 2026 Medicare rates, a pathology exam of biopsy tissue costs up to about $88 in total at a hospital outpatient department, counting both the physician and the facility (national rates). Outside a hospital, at an independent imaging center, lab or office, Medicare's full rate in California averages $79, from $75 in Chico to $92 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). Enter a ZIP for the exact California locality.
Yes. CMS splits California into 29 payment localities. For this CPT the office physician fee spans $17.86 from the lowest to highest locality. A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $16 for the office physician line or $8 for the hospital physician line in California. Medigap may cover that 20%. This is not the hospital facility fee.
It depends on where the test is done. At an independent imaging center, lab or office, $78.98 is Medicare's full rate in California, covering the test and the reading. In a hospital outpatient department the physician is paid only for the reading (about $37.69) and the hospital is paid separately, which brings the national total to up to about $88. California ranks #49 of 51 states on the non-hospital rate (13% above the national office rate of $70.14).