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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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ยฉ 2026 OpenMedicare. Independent data journalism. Built by TheDataProject.ai

Methodologyโ€ขDownload Data
  1. Home
  2. Providers
  3. Carolina Montes
๐Ÿ”ฌ
MDIndividual

Carolina Montes, MD

NPI: 1861480980
Alpharetta, GA
10 years of data
Pathology
$3.8M
Total Payments
58.1K
Beneficiaries
59.6K
Services
2.14x
Markup Ratio

Peer Comparison

99th
percentile in specialty
This provider$3.8M
Specialty median$84.1K

๐Ÿ“‹ Key Findings

1Billed $3.8M over 10 years
22.14x markup ratio (above median)
399th percentile in Pathology by payments
4Payments surged 393% in 2016
511 procedures with >3x markup
โœ“ No flags detected

๐Ÿ”Ž Data Analysis

This provider's $3.8M in total Medicare payments ranks in the 99th percentile of Pathology providers nationally.

Medicare payments to this provider grew 2043% from 2014 to 2023.

AI-generated analysis based on Medicare payment data.

Annual Medicare Payments

Annual Services Provided

Avg Payment per Service

Markup Ratio Over Time

๐Ÿ“ˆ

Notable: Payments increased 393% in 2016

Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.

Submitted Charges vs. Medicare Payments

Average per-service amounts submitted by the provider compared to what Medicare actually paid โ€” the gap represents the markup.

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2014$151.35$29.875.07x$121.48$35.6K1.3K1.3K
2015$171.87$37.704.56x$134.17$43.7K1.1K1.1K
2016$221.38$57.623.84x$163.76$215.5K4.1K3.6K
2017$222.05$58.423.80x$163.63$199.2K3.9K3.5K
2018$148.02$59.572.48x$88.45$132.5K2.3K2.3K
2019$102.66$63.461.62x$39.20$538.9K8.4K8.3K
2020$103.30$64.271.61x$39.03$427.6K6.6K6.6K
2021$105.06$68.261.54x$36.80$656.0K9.3K9.2K
2022$105.12$65.381.61x$39.74$765.2K11.0K10.9K
2023$105.11$63.251.66x$41.86$763.5K11.4K11.3K

Top Procedures (15)

88305Pathology examination of tissue using a microscope, intermediate complexityโš  3.1x markup
$1.5M
29.9K services$51.09/svc3.10x markup
88312Special stained specimen slides to identify organisms including interpretation and report
$1.5M
17.6K services$85.12/svc1.37x markup
88313Special stained specimen slides to examine tissue including interpretation and report
$481.5K
7.7K services$62.64/svc1.33x markup
88342Tissue or cell analysis by immunologic technique
$174.9K
2.2K services$78.61/svc2.28x markup
88341Special stained specimen slides to examine tissue
$45.7K
666 services$68.59/svc1.87x markup
88304Pathology examination of tissue using a microscope, moderately low complexityโš  3.4x markup
$28.9K
1.0K services$27.74/svc3.44x markup
88307Pathology examination of tissue using a microscope, moderately high complexityโš  4.6x markup
$5.2K
81 services$63.87/svc4.60x markup
88321Surgical pathology consultation and reportโš  3.3x markup
$4.3K
57 services$76.22/svc3.25x markup
88309Pathology examination of tissue using a microscope, high complexityโš  3.0x markup
$3.7K
33 services$113.12/svc3.05x markup
G0461Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stainโš  4.8x markup
$2.8K
119 services$23.38/svc4.79x markup
88331Pathology examination of tissue during surgeryโš  3.3x markup
$1.7K
36 services$46.34/svc3.28x markup
G0462Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure)โš  9.5x markup
$545.25
53 services$10.29/svc9.53x markup
88361Microscopic genetic analysis of tumorโš  4.2x markup
$506.31
12 services$42.19/svc4.15x markup
88311Preparation of tissue for examination by removing any calcium presentโš  4.6x markup
$390.84
45 services$8.69/svc4.61x markup
88300Pathology examination of tissue using a microscope, limited examinationโš  11.8x markup
$37.40
11 services$3.40/svc11.76x markup
Show detailed table โ–พ
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
88305Pathology examination of tissue using a microscope, intermediate complexity29.9K$1.5M$51.093.10x
88312Special stained specimen slides to identify organisms including interpretation and report17.6K$1.5M$85.121.37x
88313Special stained specimen slides to examine tissue including interpretation and report7.7K$481.5K$62.641.33x
88342Tissue or cell analysis by immunologic technique2.2K$174.9K$78.612.28x
88341Special stained specimen slides to examine tissue666$45.7K$68.591.87x
88304Pathology examination of tissue using a microscope, moderately low complexity1.0K$28.9K$27.743.44x
88307Pathology examination of tissue using a microscope, moderately high complexity81$5.2K$63.874.60x
88321Surgical pathology consultation and report57$4.3K$76.223.25x
88309Pathology examination of tissue using a microscope, high complexity33$3.7K$113.123.05x
G0461Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain119$2.8K$23.384.79x
88331Pathology examination of tissue during surgery36$1.7K$46.343.28x
G0462Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure)53$545.25$10.299.53x
88361Microscopic genetic analysis of tumor12$506.31$42.194.15x
88311Preparation of tissue for examination by removing any calcium present45$390.84$8.694.61x
88300Pathology examination of tissue using a microscope, limited examination11$37.40$3.4011.76x

Markup Analysis

Charge-to-Payment Ratio

2.14x

This provider submits charges 2.14 times higher than what Medicare actually pays.

What This Means

A markup ratio of 2.14x means for every $100 Medicare pays, this provider initially charges $214. This is higher than the national average.

Location

Alpharetta, GA

Provider Verification

Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.

Similar Providers

Other Pathology providers in GA for peer comparison.

Carolina Montes (you)
$3.8M
Scott Acker, MD
$50.6M
Show detailed table โ–พ
ProviderLocationTotal PaymentsStatus
Scott Acker, MDAlpharetta, GA$50.6Mโœ“ Clear

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Data Sources

  • โ€ข Centers for Medicare & Medicaid Services (CMS)
  • โ€ข Medicare Provider Utilization and Payment Data (2014-2023)
  • โ€ข National Plan and Provider Enumeration System (NPPES)

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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