Statistical flag only — not an accusation of fraud
This provider's $23.3M in total Medicare payments ranks in the 96th percentile of Clinical Laboratory providers nationally.
Their average markup ratio of 6.06x is significantly above the specialty median of 3.7x.
This provider has been statistically flagged with a risk score of 71/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 54% 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 | $72.87 | $13.83 | 5.27x | $59.04 | $3.5M | 249.8K | 160 |
| 2015 | $72.64 | $14.19 | 5.12x | $58.45 | $2.8M | 197.2K | 125 |
| 2016 | $72.69 | $14.63 | 4.97x | $58.06 | $2.5M | 170.5K | 107 |
| 2017 | $72.93 | $14.41 | 5.06x | $58.52 | $2.2M | 155.8K | 100 |
| 2018 | $71.78 | $13.75 | 5.22x | $58.03 | $1.9M | 139.8K | 90 |
| 2019 | $72.11 | $12.26 | 5.88x | $59.85 | $1.7M | 136.4K | 89 |
| 2020 | $65.42 | $10.58 | 6.18x | $54.84 | $1.2M | 116.7K | 88 |
| 2021 | $64.21 | $9.18 | 6.99x | $55.03 | $1.9M | 207.8K | 103 |
| 2022 | $67.03 | $8.54 | 7.85x | $58.49 | $2.5M | 287.2K | 97 |
| 2023 | $72.18 | $9.08 | 7.95x | $63.10 | $3.1M | 341.3K | 97 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 61.5K | $2.3M | $37.09 | 3.55x |
| G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision | 64.2K | $1.7M | $26.39 | 4.10x |
| 87086 | Bacterial colony count, urine | 187.6K | $1.6M | $8.75 | 6.88x |
| 80053 | Blood test, comprehensive group of blood chemicals | 133.7K | $1.4M | $10.40 | 7.82x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 139.0K | $1.2M | $8.41 | 5.32x |
| 87088 | Bacterial urine culture | 136.3K | $1.1M | $8.03 | 4.30x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 75.4K | $1.1M | $14.10 | 10.56x |
| 87186 | Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution | 104.6K | $1.0M | $9.99 | 7.05x |
| 87077 | Bacterial culture for aerobic isolates | 97.8K | $904.6K | $9.25 | 3.75x |
| 83036 | Hemoglobin a1c level | 81.4K | $790.3K | $9.71 | 7.73x |
| 87624 | Detection test for human papillomavirus (hpv) | 14.7K | $678.2K | $46.23 | 2.76x |
| 36415 | Insertion of needle into vein for collection of blood sample | 137.9K | $565.8K | $4.10 | 5.37x |
| 85610 | Blood test, clotting time | 107.5K | $519.3K | $4.83 | 7.74x |
| 87209 | Special stain for parasites | 20.7K | $438.7K | $21.23 | 5.53x |
| 87070 | Bacterial culture, any other source except urine, blood or stool, aerobic | 40.1K | $409.2K | $10.21 | 9.05x |
| 87449 | Detection test by immunoassay technique for other organism | 26.9K | $368.8K | $13.70 | 9.71x |
| 88175 | Pap test, automated thin layer preparation; automated system and manual rescreening | 13.9K | $367.1K | $26.39 | 4.09x |
| 87427 | Detection test by immunoassay technique for shiga-like toxin (bacterial toxin) | 24.8K | $344.5K | $13.91 | 8.18x |
| G0123 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision | 16.3K | $337.9K | $20.72 | 4.12x |
| 87324 | Detection test by immunoassay technique for clostridium difficile toxins (stool pathogen) | 21.8K | $312.5K | $14.33 | 9.10x |
This provider submits charges 6.06 times higher than what Medicare actually pays.
A markup ratio of 6.06x means for every $100 Medicare pays, this provider initially charges $606. 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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