pathology2020: I would negotiate, tell the GI group nicely but firmly that $12 per slide is way below the going rate. Tell them they will be violating stark's in office exception if they pay you below 75% of medicare PC. This will come around $28 per specimen. I wouldnt go below $25 per specimen in any circumstances and you can also charge separately for stains. I have actually consulted some well known attorneys in past and got the figure of 70-75% of medicare PC for these kind of deals. The physician group will have to pay you fair market value and also cover your malpractice (ideally with tail) . They will also have to provide you with an office, microscope and transcrpition service and pay for it. I second LADOC above, ask for separate fee for medical directorship, I would also go for $3K-$5K per month. Your resposnsibilities as medical director should be clearly written in contract and it should be stated that your stipend is 'independent' of volume to fulfill the stark law. With 15K specimens, you should be taking home atleast $500K., preferably around $600K. I would also add another thing, you should be the exclusive provider of pathology services to the group by contract. Remember this, Inoffice exception to stark law will eventually go away , its only a matter of time, when this happens and if you have some contractual leverage and relationship, you can set up your own TC lab and get the complete pie. In any case, this is a business opportunity but don't sell yourself short. One more thing, no national lab can legally do the medicare work for $12 per specimen. It's illegal to client bill medicare cases in outpatient setting. It's possible, they are getting some dirt cheap client bill deal on private insurance cases from a national lab, even those hover around $20-25 but remember the national lab is getting full prosfessional on medicare cases which with stains will be around $45-$50 just for professional more if they are billing globally. The GI group will be making a boat load of money out of you, which is OK, as long as they are paying you fair market value.