This provider's $52.6M in total Medicare payments ranks in the 98th percentile of Clinical Laboratory providers nationally.
69% of their billing comes from a single procedure code (81538 — Testing of lung tumor cells for prediction of survival).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 70% in 2016
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 |
|---|---|---|---|---|---|---|---|
| 2015 | $2.4K | $1.3K | 1.80x | $1.0K | $3.0M | 2.3K | 4 |
| 2016 | $1.4K | $682.30 | 2.06x | $722.83 | $5.1M | 7.5K | 6 |
| 2017 | $1.4K | $680.88 | 2.03x | $701.13 | $8.0M | 11.8K | 5 |
| 2018 | $1.5K | $867.24 | 1.69x | $596.48 | $11.4M | 13.2K | 5 |
| 2019 | $1.3K | $673.10 | 1.86x | $578.11 | $8.6M | 12.8K | 7 |
| 2020 | $1.2K | $663.62 | 1.85x | $563.67 | $4.5M | 6.8K | 8 |
| 2021 | $1.3K | $724.32 | 1.76x | $553.37 | $3.7M | 5.0K | 8 |
| 2022 | $2.4K | $1.6K | 1.50x | $812.69 | $4.0M | 2.5K | 6 |
| 2023 | $2.5K | $1.5K | 1.64x | $985.44 | $4.2M | 2.7K | 4 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 81538 | Testing of lung tumor cells for prediction of survival | 14.0K | $36.1M | $2.6K | 1.43x |
| 81235 | Gene analysis (epidermal growth factor receptor), common variants | 13.8K | $4.4M | $320.86 | 3.04x |
| 84999 | Chemistry procedures | 1.4K | $2.9M | $2.1K | 1.69x |
| 81455 | Targeted genomic sequence analysis panel of dna or combine dna and rna of 51 or greater genes associated with blood and lymphatic system disorders | 995 | $2.9M | $2.9K | 1.55x |
| 81275 | Gene analysis (v-ki-ras2 kirsten rat sarcoma viral oncogene) variants in codons 12 and 13 | 13.1K | $2.5M | $191.38 | 3.04x |
| 81210 | Gene analysis (v-raf murine sarcoma viral oncogene homolog b1) | 13.1K | $2.3M | $173.71 | 3.07x |
| 81404 | Molecular pathology procedure level 5 | 3.8K | $1.0M | $271.19 | 2.90x |
| 81401 | Molecular pathology procedure level 2 | 3.8K | $519.8K | $135.19 | 5.99x |
| 81479 | Molecular pathology procedure | 464 | $65.4K | $140.97 | 5.92x |
| 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 | 162 | $14.6K | $89.81 | 1.11x |
This provider submits charges 1.81 times higher than what Medicare actually pays.
A markup ratio of 1.81x means for every $100 Medicare pays, this provider initially charges $181. This is lower 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 CO for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Laboratory Corporation Of America | Englewood, CO | $139.3M | ⚠️ 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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