Statistical flag only — not an accusation of fraud
This provider's $69.3M in total Medicare payments ranks in the 99th percentile of Clinical Laboratory providers nationally.
Their average markup ratio of 7.55x is significantly above the specialty median of 3.7x.
Medicare payments to this provider grew 74% from 2019 to 2023.
This provider has been statistically flagged with a risk score of 77/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 89% in 2020
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 |
|---|---|---|---|---|---|---|---|
| 2019 | $84.37 | $11.85 | 7.12x | $72.52 | $8.4M | 706.0K | 234 |
| 2020 | $85.77 | $11.36 | 7.55x | $74.41 | $15.8M | 1.4M | 264 |
| 2021 | $86.77 | $11.48 | 7.56x | $75.29 | $15.6M | 1.4M | 250 |
| 2022 | $87.82 | $11.50 | 7.64x | $76.32 | $14.9M | 1.3M | 250 |
| 2023 | $91.00 | $11.84 | 7.69x | $79.16 | $14.6M | 1.2M | 231 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 80053 | Blood test, comprehensive group of blood chemicals | 634.1K | $6.7M | $10.58 | 8.17x |
| 82306 | Vitamin d-3 level | 211.2K | $6.3M | $29.60 | 6.92x |
| 84443 | Blood test, thyroid stimulating hormone (tsh) | 364.1K | $6.1M | $16.83 | 7.75x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 435.6K | $5.8M | $13.41 | 11.01x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 495.6K | $3.9M | $7.78 | 5.90x |
| 36415 | Insertion of needle into vein for collection of blood sample | 676.2K | $2.7M | $3.98 | 5.56x |
| 83036 | Hemoglobin a1c level | 273.1K | $2.7M | $9.73 | 7.67x |
| 86480 | Tuberculosis test, gamma interferon | 38.0K | $2.4M | $61.93 | 5.47x |
| 83970 | Parathormone (parathyroid hormone) level | 45.0K | $1.9M | $41.34 | 5.80x |
| 82607 | Cyanocobalamin (vitamin b-12) level | 81.7K | $1.2M | $15.09 | 8.01x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 47.6K | $1.1M | $24.09 | 5.06x |
| 87086 | Bacterial colony count, urine | 137.1K | $1.1M | $8.08 | 7.58x |
| 84439 | Thyroxine (thyroid chemical), free | 115.9K | $1.0M | $9.03 | 16.25x |
| 84153 | Psa (prostate specific antigen) measurement, total | 51.0K | $940.0K | $18.41 | 7.78x |
| 80048 | Blood test, basic group of blood chemicals (calcium, total) | 109.6K | $931.1K | $8.49 | 7.94x |
| 87088 | Bacterial urine culture | 102.7K | $832.8K | $8.11 | 4.19x |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | 43.3K | $832.2K | $19.23 | 7.63x |
| 82728 | Ferritin (blood protein) level | 60.5K | $824.8K | $13.64 | 8.29x |
| 83880 | Natriuretic peptide (heart and blood vessel protein) level | 16.3K | $634.7K | $38.83 | 4.94x |
| 84481 | Thyroid hormone, t3 measurement, free | 36.5K | $618.6K | $16.96 | 13.38x |
This provider submits charges 7.55 times higher than what Medicare actually pays.
A markup ratio of 7.55x means for every $100 Medicare pays, this provider initially charges $755. 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 NC for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Laboratory Corporation Of America Holdings | Burlington, NC | $2.2B | ⚠️ Flagged |
| Pathgroup Labs, Llc | Greensboro, NC | $203.7M | ⚠️ Flagged |
| Mako Medical Laboratories, Llc | Raleigh, NC | $107.0M | ✓ Clear |
| Laboratory Corporation Of America Holdings | Research Triangle Park, NC | $65.4M | ✓ Clear |
| Laboratory Corporation Of America Holdings | Research Triangle Park, NC | $61.5M | ⚠️ Flagged |
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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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