Statistical flag only — not an accusation of fraud
This provider's $476.1M in total Medicare payments ranks in the 99th percentile of Clinical Laboratory providers nationally.
Their average markup ratio of 6.53x is significantly above the specialty median of 3.7x.
This provider has been statistically flagged with a risk score of 85/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
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 | $70.40 | $12.58 | 5.60x | $57.82 | $44.2M | 3.5M | 412 |
| 2015 | $75.00 | $12.94 | 5.80x | $62.06 | $45.3M | 3.5M | 402 |
| 2016 | $76.17 | $12.88 | 5.91x | $63.29 | $52.1M | 4.0M | 395 |
| 2017 | $74.47 | $12.26 | 6.07x | $62.21 | $49.0M | 4.0M | 358 |
| 2018 | $75.87 | $12.33 | 6.15x | $63.54 | $51.0M | 4.1M | 364 |
| 2019 | $78.62 | $11.23 | 7.00x | $67.39 | $48.0M | 4.3M | 354 |
| 2020 | $80.14 | $11.37 | 7.05x | $68.77 | $43.8M | 3.9M | 358 |
| 2021 | $82.90 | $11.61 | 7.14x | $71.29 | $49.1M | 4.2M | 355 |
| 2022 | $84.07 | $11.60 | 7.25x | $72.47 | $46.5M | 4.0M | 367 |
| 2023 | $88.37 | $11.96 | 7.39x | $76.41 | $47.1M | 3.9M | 368 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 80053 | Blood test, comprehensive group of blood chemicals | 4.0M | $43.6M | $10.84 | 7.26x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 2.8M | $40.4M | $14.57 | 9.94x |
| 84443 | Blood test, thyroid stimulating hormone (tsh) | 2.0M | $38.5M | $19.36 | 6.48x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 3.1M | $28.2M | $8.96 | 4.90x |
| 82306 | Vitamin d-3 level | 632.9K | $21.5M | $34.04 | 7.06x |
| 83036 | Hemoglobin a1c level | 1.9M | $20.7M | $11.18 | 6.50x |
| 36415 | Insertion of needle into vein for collection of blood sample | 5.9M | $20.4M | $3.45 | 6.52x |
| 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 | 126.7K | $13.9M | $109.94 | 1.69x |
| 82607 | Cyanocobalamin (vitamin b-12) level | 559.6K | $9.7M | $17.36 | 6.63x |
| 84153 | Psa (prostate specific antigen) measurement, total | 415.2K | $8.8M | $21.15 | 6.80x |
| 80307 | Testing for presence of drug, by chemistry analyzers | 131.9K | $8.6M | $65.11 | 2.39x |
| 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 | 96.2K | $7.9M | $81.68 | 1.19x |
| 80048 | Blood test, basic group of blood chemicals (calcium, total) | 720.8K | $6.6M | $9.10 | 6.55x |
| 84439 | Thyroxine (thyroid chemical), free | 610.7K | $6.3M | $10.35 | 13.46x |
| 87086 | Bacterial colony count, urine | 614.1K | $5.7M | $9.34 | 6.58x |
| 85027 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 743.2K | $5.5M | $7.41 | 4.94x |
| 82570 | Creatinine level to test for kidney function or muscle injury | 921.1K | $5.5M | $5.96 | 9.69x |
| 82043 | Urine microalbumin (protein) level | 762.8K | $5.1M | $6.63 | 10.40x |
| 82728 | Ferritin (blood protein) level | 322.2K | $5.0M | $15.46 | 7.11x |
| 82746 | Folic acid level, serum | 290.6K | $4.9M | $16.91 | 6.65x |
This provider submits charges 6.53 times higher than what Medicare actually pays.
A markup ratio of 6.53x means for every $100 Medicare pays, this provider initially charges $653. 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 CA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Genomic Health, Inc. | Redwood City, CA | $887.6M | ✓ Clear |
| Unilab Corporation | West Hills, CA | $868.8M | ⚠️ Flagged |
| Caredx Inc. | Brisbane, CA | $751.0M | ✓ Clear |
| Laboratory Corporation Of America | San Diego, CA | $592.4M | ⚠️ Flagged |
| Millennium Health, Llc | San Diego, CA | $587.9M | ✓ 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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