This provider's $5.5M in total Medicare payments ranks in the 99th percentile of Pathology providers nationally.
Medicare payments to this provider grew 1189% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 193% in 2017
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 | $144.21 | $30.74 | 4.69x | $113.47 | $57.8K | 2.1K | 2.1K |
| 2015 | $150.56 | $31.68 | 4.75x | $118.88 | $54.5K | 2.1K | 2.0K |
| 2016 | $228.19 | $71.11 | 3.21x | $157.08 | $145.1K | 1.8K | 1.7K |
| 2017 | $445.17 | $154.18 | 2.89x | $290.99 | $424.9K | 3.2K | 3.0K |
| 2018 | $567.47 | $255.69 | 2.22x | $311.78 | $758.6K | 4.5K | 4.2K |
| 2019 | $752.21 | $196.29 | 3.83x | $555.92 | $943.5K | 5.1K | 4.7K |
| 2020 | $782.45 | $193.91 | 4.04x | $588.54 | $785.1K | 4.3K | 4.0K |
| 2021 | $950.21 | $240.44 | 3.95x | $709.77 | $820.3K | 4.3K | 4.0K |
| 2022 | $879.50 | $216.82 | 4.06x | $662.68 | $791.5K | 4.0K | 3.8K |
| 2023 | $879.49 | $208.60 | 4.22x | $670.89 | $745.3K | 4.0K | 3.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method | 5.5K | $1.9M | $353.89 | 3.14x |
| 88121 | Cell examination of urine | 3.0K | $1.3M | $444.85 | 4.55x |
| 88112 | Cell examination of specimen | 15.9K | $968.7K | $60.98 | 4.47x |
| 88307 | Pathology examination of tissue using a microscope, moderately high complexity | 1.6K | $392.6K | $240.54 | 2.68x |
| 88120 | Cell examination of urine | 647 | $384.8K | $594.78 | 4.48x |
| 88344 | Special stained specimen slides to examine tissue | 1.5K | $241.7K | $162.33 | 2.48x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 3.6K | $165.5K | $45.55 | 4.97x |
| 88342 | Tissue or cell analysis by immunologic technique | 303 | $20.0K | $66.10 | 4.99x |
| 88341 | Special stained specimen slides to examine tissue | 185 | $9.6K | $51.98 | 3.71x |
| 88309 | Pathology examination of tissue using a microscope, high complexity | 74 | $8.8K | $119.02 | 3.44x |
| 88304 | Pathology examination of tissue using a microscope, moderately low complexity | 506 | $8.1K | $16.01 | 6.34x |
| 88331 | Pathology examination of tissue during surgery | 153 | $7.9K | $51.90 | 4.05x |
| 88311 | Preparation of tissue for examination by removing any calcium present | 679 | $7.0K | $10.38 | 6.26x |
| 88173 | Evaluation of fine needle aspirate with interpretation and report | 101 | $5.8K | $57.42 | 4.53x |
| 88312 | Special stained specimen slides to identify organisms including interpretation and report | 251 | $5.7K | $22.65 | 4.22x |
| 88104 | Cell examination of body fluid | 174 | $4.1K | $23.77 | 4.63x |
| 88321 | Surgical pathology consultation and report | 57 | $3.9K | $68.40 | 3.80x |
| 85060 | Blood smear interpretation by physician with written report | 170 | $3.3K | $19.57 | 3.83x |
| 88313 | Special stained specimen slides to examine tissue including interpretation and report | 317 | $3.2K | $10.14 | 4.47x |
| 84165 | Protein measurement, serum | 200 | $3.0K | $15.05 | 4.98x |
This provider submits charges 3.83 times higher than what Medicare actually pays.
A markup ratio of 3.83x means for every $100 Medicare pays, this provider initially charges $383. 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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