Statistical flag only — not an accusation of fraud
This provider's $276.5M in total Medicare payments ranks in the 99th percentile of Clinical Laboratory providers nationally.
Their average markup ratio of 6.02x is significantly above the specialty median of 3.7x.
Medicare payments to this provider grew 234% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 82/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 208% in 2015
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 | $73.81 | $12.91 | 5.72x | $60.90 | $8.3M | 643.6K | 286 |
| 2015 | $75.85 | $13.06 | 5.81x | $62.79 | $25.6M | 2.0M | 381 |
| 2016 | $81.58 | $14.12 | 5.78x | $67.46 | $27.6M | 2.0M | 368 |
| 2017 | $86.85 | $15.44 | 5.63x | $71.41 | $30.1M | 1.9M | 367 |
| 2018 | $84.19 | $15.23 | 5.53x | $68.96 | $33.3M | 2.2M | 382 |
| 2019 | $85.53 | $13.74 | 6.22x | $71.79 | $33.6M | 2.4M | 386 |
| 2020 | $82.79 | $14.12 | 5.86x | $68.67 | $30.6M | 2.2M | 375 |
| 2021 | $82.84 | $13.49 | 6.14x | $69.35 | $31.5M | 2.3M | 378 |
| 2022 | $84.83 | $12.97 | 6.54x | $71.86 | $28.3M | 2.2M | 386 |
| 2023 | $88.59 | $13.03 | 6.80x | $75.56 | $27.8M | 2.1M | 384 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms | 215.5K | $22.8M | $105.81 | 2.48x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 1.2M | $17.3M | $14.78 | 9.92x |
| 84443 | Blood test, thyroid stimulating hormone (tsh) | 800.3K | $15.3M | $19.09 | 6.80x |
| 82306 | Vitamin d-3 level | 404.0K | $13.6M | $33.64 | 7.24x |
| 80053 | Blood test, comprehensive group of blood chemicals | 1.2M | $12.8M | $10.52 | 7.15x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 1.1M | $9.9M | $8.84 | 4.99x |
| 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 throughput technologies as described by cms-2020-01-r | 108.8K | $9.4M | $86.38 | 1.16x |
| 36415 | Insertion of needle into vein for collection of blood sample | 2.5M | $8.9M | $3.60 | 6.05x |
| 80307 | Testing for presence of drug, by chemistry analyzers | 132.4K | $8.5M | $63.99 | 2.90x |
| 83036 | Hemoglobin a1c level | 660.5K | $7.3M | $11.08 | 6.67x |
| 80048 | Blood test, basic group of blood chemicals (calcium, total) | 644.4K | $5.6M | $8.72 | 6.48x |
| 84153 | Psa (prostate specific antigen) measurement, total | 219.1K | $4.5M | $20.70 | 6.87x |
| 87086 | Bacterial colony count, urine | 479.9K | $4.5M | $9.30 | 6.44x |
| 82607 | Cyanocobalamin (vitamin b-12) level | 248.6K | $4.2M | $17.03 | 7.03x |
| 83970 | Parathormone (parathyroid hormone) level | 90.1K | $4.2M | $46.29 | 4.87x |
| 87088 | Bacterial urine culture | 415.6K | $3.9M | $9.30 | 3.14x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 117.5K | $3.5M | $30.18 | 3.58x |
| 85027 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 399.7K | $2.9M | $7.31 | 5.12x |
| 82728 | Ferritin (blood protein) level | 171.1K | $2.6M | $15.19 | 7.38x |
| 87186 | Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution | 253.3K | $2.5M | $9.93 | 7.11x |
This provider submits charges 6.02 times higher than what Medicare actually pays.
A markup ratio of 6.02x means for every $100 Medicare pays, this provider initially charges $602. This is higher than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
Other Clinical Laboratory providers in MA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Quest Diagnostics Llc | Marlborough, MA | $268.6M | ⚠️ Flagged |
| Foundation Medicine, Inc. | Cambridge, MA | $232.3M | ✓ Clear |
| Boston Heart Diagnostics Corporation | Framingham, MA | $185.1M | ✓ Clear |
| Cohen Dermatopathology, P.C. | Needham, MA | $88.9M | ✓ Clear |
| U S Lab & Radiology Llc | Brockton, MA | $71.4M | ✓ Clear |
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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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