This provider's $4.3M in total Medicare payments ranks in the 99th percentile of Pathology providers nationally.
Medicare payments to this provider grew 358% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 323% in 2023
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 | $724.40 | $204.63 | 3.54x | $519.77 | $278.2K | 2.7K | 2.6K |
| 2015 | $539.64 | $158.89 | 3.40x | $380.75 | $371.8K | 3.6K | 3.5K |
| 2016 | $527.06 | $151.46 | 3.48x | $375.60 | $378.7K | 3.3K | 3.2K |
| 2017 | $524.20 | $141.21 | 3.71x | $382.99 | $358.7K | 3.4K | 3.2K |
| 2018 | $527.00 | $135.76 | 3.88x | $391.24 | $346.7K | 3.5K | 3.3K |
| 2019 | $514.85 | $138.72 | 3.71x | $376.13 | $321.0K | 2.8K | 2.6K |
| 2020 | $555.00 | $149.35 | 3.72x | $405.65 | $347.0K | 2.9K | 2.6K |
| 2021 | $518.74 | $139.72 | 3.71x | $379.02 | $316.1K | 2.7K | 2.5K |
| 2022 | $478.88 | $124.12 | 3.86x | $354.76 | $301.2K | 2.9K | 2.7K |
| 2023 | $156.14 | $41.96 | 3.72x | $114.18 | $1.3M | 48.4K | 35.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method, 10-20 specimens | 3.4K | $1.2M | $349.81 | 3.43x |
| 88112 | Cell examination of specimen | 16.4K | $866.9K | $52.87 | 3.97x |
| 88121 | Cell examination of urine | 1.5K | $610.8K | $397.37 | 4.53x |
| 88344 | Special stained specimen slides to examine tissue | 1.6K | $229.5K | $144.71 | 2.56x |
| 84153 | Psa (prostate specific antigen) measurement, total | 12.7K | $227.5K | $17.97 | 5.01x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 4.1K | $227.5K | $55.54 | 6.71x |
| 87900 | Infectious agent drug susceptibility analysis | 1.4K | $177.4K | $127.60 | 3.06x |
| 88342 | Tissue or cell analysis by immunologic technique | 1.8K | $157.0K | $85.16 | 3.82x |
| 88341 | Special stained specimen slides to examine tissue | 1.1K | $83.2K | $77.60 | 3.78x |
| 87086 | Bacterial colony count, urine | 9.3K | $73.0K | $7.88 | 3.81x |
| 84403 | Testosterone (hormone) level, total | 1.9K | $48.3K | $25.10 | 4.38x |
| 88313 | Special stained specimen slides to examine tissue including interpretation and report | 773 | $44.3K | $57.25 | 3.70x |
| 88307 | Pathology examination of tissue using a microscope, moderately high complexity | 149 | $35.6K | $238.66 | 2.10x |
| 87186 | Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution | 4.0K | $33.4K | $8.45 | 3.56x |
| 87088 | Bacterial urine culture | 2.9K | $23.0K | $7.89 | 3.80x |
| 87482 | Detection test for candida species (yeast), quantification | 402 | $22.0K | $54.63 | 3.06x |
| G0461 | Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain | 230 | $18.3K | $79.59 | 3.79x |
| 87799 | Detection test by nucleic acid for organism, quantification | 401 | $16.8K | $41.98 | 3.07x |
| 87652 | Detection test by nucleic acid for strep (streptococcus, group a), quantification | 402 | $16.4K | $40.92 | 3.05x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 2.2K | $16.3K | $7.57 | 4.62x |
This provider submits charges 3.95 times higher than what Medicare actually pays.
A markup ratio of 3.95x means for every $100 Medicare pays, this provider initially charges $395. 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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