This provider's $3.3M in total Medicare payments ranks in the 99th percentile of Pathology providers nationally.
Medicare payments to this provider grew 4055% from 2014 to 2023.
74% of their billing comes from a single procedure code (G0416 — Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 1150% in 2015
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2014 | $64.33 | $24.41 | 2.64x | $39.92 | $9.1K | 368 | 217 |
| 2015 | $183.28 | $77.01 | 2.38x | $106.27 | $113.4K | 605 | 579 |
| 2016 | $167.26 | $65.35 | 2.56x | $101.91 | $296.4K | 2.5K | 1.8K |
| 2017 | $299.99 | $72.04 | 4.16x | $227.95 | $210.6K | 1.7K | 1.6K |
| 2018 | $381.11 | $59.68 | 6.39x | $321.43 | $300.5K | 2.7K | 2.5K |
| 2019 | $470.36 | $79.76 | 5.90x | $390.60 | $310.3K | 2.8K | 2.7K |
| 2020 | $494.48 | $69.78 | 7.09x | $424.70 | $257.8K | 2.7K | 2.6K |
| 2021 | $426.33 | $101.48 | 4.20x | $324.85 | $662.9K | 5.2K | 4.9K |
| 2022 | $309.02 | $77.75 | 3.97x | $231.27 | $767.6K | 4.9K | 4.9K |
| 2023 | $236.72 | $58.62 | 4.04x | $178.10 | $376.8K | 2.3K | 2.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method | 9.9K | $2.5M | $246.72 | 3.06x |
| 88344 | Special stained specimen slides to examine tissue | 4.4K | $426.3K | $97.08 | 3.76x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 3.1K | $117.3K | $37.52 | 6.11x |
| 88112 | Cell examination of specimen | 2.7K | $69.4K | $25.89 | 6.57x |
| 88342 | Tissue or cell analysis by immunologic technique | 1.1K | $62.6K | $57.16 | 3.23x |
| 88120 | Cell examination of urine | 610 | $41.9K | $68.74 | 17.14x |
| 88341 | Special stained specimen slides to examine tissue | 624 | $35.1K | $56.21 | 4.09x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 537 | $27.4K | $51.06 | 2.21x |
| 88121 | Cell examination of urine | 119 | $21.8K | $182.78 | 6.16x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 557 | $9.7K | $17.49 | 3.42x |
| 88108 | Cell examination of specimen | 498 | $9.6K | $19.34 | 8.85x |
| 88360 | Microscopic genetic analysis of tumor | 215 | $8.7K | $40.38 | 3.10x |
| 88312 | Special stained specimen slides to identify organisms including interpretation and report | 120 | $8.1K | $67.14 | 2.52x |
| 88304 | Pathology examination of tissue using a microscope, moderately low complexity | 119 | $3.8K | $31.58 | 2.56x |
| 88377 | Microscopic genetic examination manual | 72 | $3.7K | $51.73 | 7.38x |
| 88313 | Special stained specimen slides to examine tissue including interpretation and report | 297 | $2.9K | $9.73 | 5.06x |
| 88311 | Preparation of tissue for examination by removing any calcium present | 119 | $1.8K | $15.28 | 2.49x |
| 99195 | Therapeutic removal of whole blood to correct blood level imbalance | 13 | $831.69 | $63.98 | 2.58x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 12 | $740.12 | $61.68 | 2.72x |
| J1080 | Injection, testosterone cypionate, 1 cc, 200 mg | 117 | $459.98 | $3.93 | 5.09x |
This provider submits charges 3.56 times higher than what Medicare actually pays.
A markup ratio of 3.56x means for every $100 Medicare pays, this provider initially charges $356. This is higher than the national average.
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Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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