This provider's $5.5M 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.
Notable: Payments increased 87% in 2021
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 | $751.98 | $227.40 | 3.31x | $524.58 | $595.8K | 2.9K | 2.4K |
| 2015 | $710.34 | $177.53 | 4.00x | $532.81 | $413.7K | 2.5K | 2.2K |
| 2016 | $532.09 | $128.94 | 4.13x | $403.15 | $391.4K | 3.5K | 3.0K |
| 2017 | $454.02 | $114.95 | 3.95x | $339.07 | $463.4K | 4.9K | 4.2K |
| 2018 | $445.01 | $105.84 | 4.20x | $339.17 | $491.9K | 6.7K | 5.9K |
| 2019 | $279.90 | $63.97 | 4.38x | $215.93 | $541.0K | 9.7K | 8.1K |
| 2020 | $212.72 | $51.11 | 4.16x | $161.61 | $604.5K | 13.9K | 11.3K |
| 2021 | $184.99 | $49.14 | 3.76x | $135.85 | $1.1M | 26.8K | 19.5K |
| 2022 | $266.84 | $65.15 | 4.10x | $201.69 | $472.3K | 4.3K | 3.7K |
| 2023 | $485.05 | $113.21 | 4.28x | $371.84 | $433.2K | 3.3K | 2.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 88120 | Cell examination of urine | 5.5K | $1.8M | $336.62 | 2.20x |
| G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method, 10-20 specimens | 3.1K | $1.2M | $392.83 | 4.96x |
| 88112 | Cell examination of specimen | 17.1K | $934.9K | $54.81 | 7.23x |
| 84153 | PSA (prostate specific antigen) measurement | 15.7K | $308.0K | $19.65 | 5.09x |
| 87801 | Detection test for multiple organisms | 3.5K | $242.0K | $69.98 | 2.50x |
| 88344 | Special stained specimen slides to examine tissue | 1.1K | $182.2K | $159.40 | 4.39x |
| 87798 | Detection test for organism | 3.5K | $122.5K | $35.06 | 2.42x |
| 87640 | Detection test for staphylococcus aureus (bacteria) | 3.5K | $122.4K | $35.07 | 2.42x |
| 87500 | Detection test for vancomycin resistance strep (vre) | 3.4K | $120.3K | $34.95 | 2.43x |
| 84154 | PSA (prostate specific antigen) measurement | 4.5K | $89.9K | $19.89 | 5.03x |
| 84403 | Testosterone (hormone) level | 3.0K | $82.8K | $27.23 | 3.27x |
| 86316 | Analysis for detection of tumor marker | 2.9K | $65.3K | $22.41 | 2.23x |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | 2.0K | $42.6K | $21.78 | 4.59x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 662 | $33.2K | $50.12 | 7.26x |
| 88342 | Tissue or cell analysis by immunologic technique | 296 | $27.5K | $92.79 | 4.03x |
| 80048 | Blood test, basic group of blood chemicals | 2.7K | $22.6K | $8.47 | 2.95x |
| G0461 | Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain | 135 | $11.4K | $84.43 | 4.44x |
| 82306 | Vitamin d-3 level | 272 | $8.0K | $29.51 | 2.88x |
| 82565 | Blood creatinine level | 1.4K | $7.5K | $5.20 | 3.85x |
| 84520 | Urea nitrogen level to assess kidney function | 1.4K | $5.8K | $4.01 | 3.73x |
This provider submits charges 4.06 times higher than what Medicare actually pays.
A markup ratio of 4.06x means for every $100 Medicare pays, this provider initially charges $406. 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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