Blood Test · 88237

Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells

Medicare Payment (avg)
$140.57
What Medicare actually pays
Billed Charge (avg)
$455.54
What providers submit
Markup
3.2x
224% above Medicare rate
33.3K
Total Services
25.4K
Beneficiaries
225
Providers
34
States with Data

Price Range Across States

Lowest State Avg
$136.86
Missouri
Highest State Avg
$140.87
Michigan

What You Might Pay

Est. Commercial Insurance
$314.88
Range: $220.42 – $440.83
Est. Cash / Self-Pay
$230.70
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Blood Test procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
Michigan $140.87 $312.00
Virginia $140.87 $427.22
West Virginia $140.87 $430.00
Utah $140.87 $421.36
Indiana $140.87 $392.03
Arizona $140.87 $600.77
Alabama $140.87 $329.80
Colorado $140.87 $515.36
Hawaii $140.87 $449.13
Illinois $140.87 $396.39
Maine $140.87 $260.30
Maryland $140.87 $507.51
Massachusetts $140.87 $566.89
Nevada $140.87 $630.40
New Mexico $140.87 $861.40
Oklahoma $140.87 $472.21
Oregon $140.87 $360.67
North Carolina $140.83 $553.41
Pennsylvania $140.79 $664.79
Minnesota $140.72 $1,065.40
California $140.67 $285.27
New York $140.65 $534.31
New Jersey $140.62 $584.92
Texas $140.58 $359.35
Ohio $140.53 $530.83
Tennessee $140.51 $593.41
Florida $140.50 $356.35
Wisconsin $140.50 $542.79
Georgia $140.49 $363.34
Connecticut $140.27 $536.68
Kansas $140.09 $591.60
Washington $139.96 $495.45
Puerto Rico $137.32 $140.13
Missouri $136.86 $520.00

What the Data Says About Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells

Across 34 states with reporting providers, CPT code 88237 (Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells) shows a national average Medicare payment of $140.57 against an average billed charge of $455.54. That gap — a 3.2x markup, or 224% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Blood Test procedures like this one saw 33.3K services billed to Medicare in 2023 by 225 distinct providers, serving 25.4K unique beneficiaries. State-level variation is significant: Missouri reports the lowest average payment at $136.86, while Michigan reports the highest at $140.87. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Blood Test category (2.24x), the estimated commercial insurance price lands near $314.88, with self-pay cash discounts commonly bringing the figure closer to $230.70. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells cost?

The national average Medicare payment for Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells (CPT 88237) is $140.57, while providers typically bill $455.54. Prices vary significantly by state, ranging from $136.86 to $140.87.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells cost with insurance?

With commercial insurance, Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells costs an estimated $314.88 on average (range: $220.42 – $440.83). Without insurance, the estimated cash price is $230.70. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells?

Missouri has the lowest average Medicare payment for Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells at $136.86, while Michigan has the highest at $140.87. This $4.01 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells?

Nationally, 225 providers billed Medicare for Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells in 2023, performing 33.3K total services for 25.4K beneficiaries across 34 states and territories.

What is the billed-to-Medicare markup for Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells?

Providers bill 3.2x what Medicare pays for Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells — a 224% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial