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NPI 1346285988 · Toledo, OH · Clinical Medical Laboratory
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Pathology Laboratories, Inc. is a clinical medical laboratory provider located in Toledo, Ohio. This profile covers 284 Medicare and 283 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Pathology Laboratories, Inc. |
| Address | 1946 N 13th St |
| City | Toledo |
| State | OH |
| ZIP | 43604 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | June 18, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $25M |
| Medicare | $3.1M |
PATHOLOGY LABORATORIES, INC. is a Clinical Medical Laboratory by taxonomy and its Medicare and Medicaid code mix shows a classic outpatient reference-lab profile: very high volumes of phlebotomy and routine panels (Medicare top codes include 36415 with 39.9K claims and $319.4K revenue, 80061 with 23.8K claims and $310K revenue, and 80053 with 27.6K claims and $276.4K revenue) and, on the Medicaid side, large volumes of STI NAATs (87491 64.1K claims, $1.7M; 87591 64K claims, $1.6M) alongside broad metabolic, endocrine and screening panels such as 84443 (136.1K claims, $1.4M) and 80053 (181.3K claims, $1.3M).
Revenue concentration differs by payer: the provider’s top three Medicare codes account for 37.2% of its $3.1M total Medicare revenue and the top three Medicaid codes account for 27.0% of its $25M total Medicaid revenue, indicating that a relatively small set of high-volume assays (Medicare: 36415, 80061, 80053; Medicaid: 87491, 87591, 84443) drive a disproportionate share of revenue on each payer.
Payer mix is heavily skewed toward Medicaid: the practice reports $25M in lifetime Medicaid revenue versus $3.1M in lifetime Medicare revenue, making Medicaid the dominant payer by scale and suggesting the lab’s customer base or contracting footprint is concentrated in Medicaid-reimbursed populations and services.
On Medicare measures the provider is a national high-volume operator for several routine services: 36415 ranks #79 of 86467 providers nationally (100th percentile; extreme outlier) and 80061 ranks #84 of 21671 providers nationally (100th percentile; notably above typical national volume), while other frequent Medicare panels such as 80053 and 84443 appear at very high national percentiles but are characterized as typical or unremarkable in volume.
Within Ohio Medicaid the lab is a major in-state player for sexual health and common panels: 87491 ranks #8 of 224 providers in-state (97th percentile) and 87591 ranks #8 of 222 providers in-state (97th percentile), while 84443 ranks #7 of 244 providers in-state (98th percentile) and 80053 ranks #9 of 274 providers in-state (97th percentile); these state-level ranks plus the absolute Medicaid revenues (87491 $1.7M, 87591 $1.6M, 84443 $1.4M) indicate substantial market share for STI NAATs and routine panels.
The reported code mix shows operational breadth beyond basic chemistry and hematology: the lab bills definitive drug testing G0480 (410 claims, $42.2K revenue Medicare; 5.3K claims, $253.9K revenue Medicaid), molecular/genotype testing such as 87902 (Medicaid $471.8K) and U0003 (Medicaid $437.2K), and algorithmic microbiome/BV testing 81514 (Medicaid $253.1K), signaling capabilities in molecular diagnostics and confirmatory testing in addition to high-throughput screening.
Statistical standing language in the file highlights clear outlier behavior on specific codes: 36415 is described as an "extreme outlier" nationally, and several high-volume Medicare codes (e.g., 80061, 85025, 83036) are described as at or near the 100th national percentile or "notably above typical," while multiple Medicaid codes sit in the 95th–99th in-state percentiles; taken together this points to systematically higher throughput than most peers for many routine assays.
The provider has long tenure in the NPI registry, enumerated on 2006-06-18 (~20 years ago), consistent with an established reference-lab operation that has scaled Medicaid-facing volumes over time rather than a recent market entrant.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
284 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 39,930 | $10 | $319.4K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 23,840 | $10 | $310K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 27,640 | $10 | $276.4K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 16,770 | $20 | $268.3K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 8,300 | $30 | $240.6K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 22,450 | $10 | $179.6K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 13,960 | $10 | $139.6K |
| 84153 | The lab analyst performs testing for total prostate specific antigen, PSA, typically on serum or plasma samples using laboratory analyzers. PSA is a protein the prostate gland produces, and… | 3,830 | $20 | $69K |
| 82607 | The lab analyst performs a test to measure the amount of vitamin B12 in a patient specimen, typically in patient blood. | 4,360 | $20 | $65.3K |
| 83970 | Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function. | 1,570 | $40 | $62.8K |
Showing 1–10 of 284
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 284 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
283 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 64,130 | $30 | $1.7M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 63,960 | $30 | $1.6M |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 136,130 | $10 | $1.4M |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 181,340 | $10 | $1.3M |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 71,810 | $20 | $1.2M |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 130,940 | $10 | $1M |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 43,190 | $20 | $993.4K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 188,400 | $10 | $942K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 48,670 | $20 | $778.7K |
| 88175 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 37,720 | $20 | $678.9K |
Showing 1–10 of 283
How this provider's Medicaid billing volume and revenue compare to other Ohio providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Ohio median
283 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 27 | 140 | 1,130 | $90 | $1.1M |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 3 | 50 | 220 | $30 | $675.9K |
| 80081 | The lab analyst performs an obstetric panel; this panel must include tests for a complete blood count with differential, a hepatitis B surface antigen test, a single–result test for HIV–1 antigens… | 6 | 20 | 480 | $50 | $671.8K |
| 81220 | The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR… | 20 | 20 | 170 | $210 | $485.4K |
| 81513 | The lab analyst performs the technical lab test on a vaginal fluid specimen for quantitative real–time amplification of RNA markers for three bacterial species listed in the code descriptor, and… | 14 | 30 | 480 | $110 | $415.5K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 53 | 340 | 2,260 | $30 | $398.2K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 5 | 140 | 410 | $30 | $384.3K |
| 87902 | The lab analyst performs the technical lab test to analyze the specific genotype by nucleic acid of a specimen containing hepatitis C virus. | 4 | 20 | 290 | $160 | $379.2K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 9 | 270 | 8,700 | $10 | $353.7K |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 3 | 60 | 330 | $40 | $323K |
Showing 1–10 of 283
Other providers in the same ZIP code as Pathology Laboratories, Inc., ranked by combined Medicare and Medicaid revenue.
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