This provider's $4.6M in total Medicare payments ranks in the 99th percentile of Pathology providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
AI-generated analysis based on Medicare payment data.
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 | $342.44 | $123.00 | 2.78x | $219.44 | $442.7K | 4.2K | 3.6K |
| 2015 | $341.61 | $116.16 | 2.94x | $225.45 | $443.8K | 3.9K | 3.1K |
| 2016 | $402.58 | $128.80 | 3.13x | $273.78 | $468.4K | 3.8K | 3.1K |
| 2017 | $500.65 | $168.22 | 2.98x | $332.43 | $445.6K | 3.7K | 3.0K |
| 2018 | $571.16 | $188.66 | 3.03x | $382.50 | $569.5K | 3.6K | 3.1K |
| 2019 | $572.13 | $177.37 | 3.23x | $394.76 | $493.2K | 3.5K | 2.9K |
| 2020 | $571.78 | $175.99 | 3.25x | $395.79 | $368.7K | 2.8K | 2.3K |
| 2021 | $501.64 | $161.80 | 3.10x | $339.84 | $450.7K | 3.2K | 2.7K |
| 2022 | $437.36 | $136.80 | 3.20x | $300.56 | $477.4K | 3.6K | 3.0K |
| 2023 | $525.15 | $160.51 | 3.27x | $364.64 | $400.6K | 3.3K | 2.8K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method, 10-20 specimens | 6.9K | $2.3M | $338.00 | 3.82x |
| 88112 | Cell examination of specimen | 23.3K | $1.1M | $49.40 | 3.90x |
| 88120 | Cell examination of urine | 1.6K | $774.9K | $486.47 | 2.48x |
| 88344 | Special stained specimen slides to examine tissue | 931 | $117.6K | $126.36 | 2.53x |
| 88307 | Pathology examination of tissue using a microscope, moderately high complexity | 194 | $42.9K | $221.26 | 2.54x |
| 88121 | Cell examination of urine | 888 | $35.1K | $39.50 | 2.48x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 812 | $34.8K | $42.87 | 4.79x |
| G0461 | Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain | 334 | $22.2K | $66.46 | 2.63x |
| G0462 | Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure) | 332 | $17.1K | $51.39 | 2.64x |
| 88321 | Surgical pathology consultation and report | 87 | $6.9K | $78.88 | 2.34x |
| 88342 | Tissue or cell analysis by immunologic technique | 89 | $5.6K | $63.41 | 3.09x |
| 88341 | Special stained specimen slides to examine tissue | 61 | $3.1K | $50.10 | 2.73x |
| 88304 | Pathology examination of tissue using a microscope, moderately low complexity | 71 | $2.4K | $33.26 | 3.75x |
This provider submits charges 3.55 times higher than what Medicare actually pays.
A markup ratio of 3.55x means for every $100 Medicare pays, this provider initially charges $355. 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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