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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Providers
  3. Pruven Health
🔬
Organization

Pruven Health

NPI: 1649758038
Addison, TX
5 years of data
Clinical Laboratory
$4.6M
Total Payments
144.5K
Beneficiaries
329.1K
Services
2.21x
Markup Ratio

Peer Comparison

79th
percentile in specialty
This provider$4.6M
Specialty median$1.9M

📋 Key Findings

1Billed $4.6M over 5 years
22.21x markup ratio (above median)
3Payments surged 351% in 2020
✓ No flags detected

🔎 Data Analysis

This provider's $4.6M in total Medicare payments ranks in the 79th percentile of Clinical Laboratory providers nationally.

Medicare payments to this provider grew 607% from 2019 to 2023.

AI-generated analysis based on Medicare payment data.

Annual Medicare Payments

Annual Services Provided

Avg Payment per Service

Markup Ratio Over Time

📈

Notable: Payments increased 351% in 2020

Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.

Submitted Charges vs. Medicare Payments

Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2019$17.50$16.771.04x$0.73$160.2K12.3K8.7K
2020$17.47$15.921.10x$1.55$721.8K51.8K21.4K
2021$35.55$15.582.28x$19.97$1.2M78.5K30.2K
2022$38.24$15.172.52x$23.07$1.3M88.0K38.2K
2023$44.59$16.312.73x$28.28$1.1M98.5K46.0K

Top Procedures (20)

U0003Infectious 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
$859.3K
10.6K services$80.93/svc1.95x markup
G0471Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha)
$368.2K
55.1K services$6.69/svc2.31x markup
80053Blood test, comprehensive group of blood chemicals
$239.0K
22.8K services$10.47/svc2.27x markup
85025Complete blood cell count (red cells, white blood cell, platelets), automated test
$233.9K
30.3K services$7.71/svc2.25x markup
G2024Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source
$179.5K
7.1K services$25.41/svc2.31x markup
U0005Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within
$158.8K
6.4K services$24.97/svc2.39x markup
84443Blood test, thyroid stimulating hormone (TSH)
$146.9K
8.8K services$16.70/svc2.22x markup
87798Detection test for organism
$129.7K
3.7K services$34.79/svc2.32x markup
87500Detection test for Vancomycin resistance strep (VRE)
$128.9K
3.7K services$34.80/svc2.33x markup
87640Detection test for Staphylococcus aureus (bacteria)
$128.3K
3.7K services$34.80/svc2.33x markup
87481Detection test for candida species (yeast)
$127.1K
3.6K services$34.81/svc2.32x markup
87653Detection test for Strep (Streptococcus, group B)
$126.1K
3.6K services$34.81/svc2.31x markup
82306Vitamin D-3 level
$121.3K
4.1K services$29.45/svc2.26x markup
87641Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)
$110.0K
3.2K services$34.88/svc2.20x markup
80048Blood test, basic group of blood chemicals
$108.8K
12.9K services$8.41/svc2.13x markup
87651Detection test for Strep (Streptococcus, group A)
$99.4K
2.8K services$34.93/svc2.17x markup
87529Detection test for herpes simplex virus
$97.7K
2.8K services$34.97/svc2.15x markup
87496Detection test for Cytomegalovirus (CMV)
$96.8K
2.8K services$34.95/svc2.15x markup
87661Detection test for Trichomonas vaginalis (genital parasite)
$95.0K
2.7K services$34.96/svc2.14x markup
87563Detection of mycoplasma genitalium by dna or rna probe
$91.5K
2.6K services$34.67/svc2.57x markup
Show detailed table ▾
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
U0003Infectious 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-r10.6K$859.3K$80.931.95x
G0471Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha)55.1K$368.2K$6.692.31x
80053Blood test, comprehensive group of blood chemicals22.8K$239.0K$10.472.27x
85025Complete blood cell count (red cells, white blood cell, platelets), automated test30.3K$233.9K$7.712.25x
G2024Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source7.1K$179.5K$25.412.31x
U0005Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within6.4K$158.8K$24.972.39x
84443Blood test, thyroid stimulating hormone (TSH)8.8K$146.9K$16.702.22x
87798Detection test for organism3.7K$129.7K$34.792.32x
87500Detection test for Vancomycin resistance strep (VRE)3.7K$128.9K$34.802.33x
87640Detection test for Staphylococcus aureus (bacteria)3.7K$128.3K$34.802.33x
87481Detection test for candida species (yeast)3.6K$127.1K$34.812.32x
87653Detection test for Strep (Streptococcus, group B)3.6K$126.1K$34.812.31x
82306Vitamin D-3 level4.1K$121.3K$29.452.26x
87641Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)3.2K$110.0K$34.882.20x
80048Blood test, basic group of blood chemicals12.9K$108.8K$8.412.13x
87651Detection test for Strep (Streptococcus, group A)2.8K$99.4K$34.932.17x
87529Detection test for herpes simplex virus2.8K$97.7K$34.972.15x
87496Detection test for Cytomegalovirus (CMV)2.8K$96.8K$34.952.15x
87661Detection test for Trichomonas vaginalis (genital parasite)2.7K$95.0K$34.962.14x
87563Detection of mycoplasma genitalium by dna or rna probe2.6K$91.5K$34.672.57x

Markup Analysis

Charge-to-Payment Ratio

2.21x

This provider submits charges 2.21 times higher than what Medicare actually pays.

What This Means

A markup ratio of 2.21x means for every $100 Medicare pays, this provider initially charges $221. This is higher than the national average.

Location

Addison, TX

Provider Verification

Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.

Similar Providers

Other Clinical Laboratory providers in TX for peer comparison.

Pruven Health (you)
$4.6M
Clinical Pathology Laboratories, Inc.⚠️
$541.0M
Quest Diagnostics Clinical Laboratories Inc⚠️
$453.2M
Laboratory Corporation Of America⚠️
$389.6M
Quest Diagnostics Clinical Laboratories Inc⚠️
$311.2M
Laboratory Corporation Of America⚠️
$299.4M
Show detailed table ▾
ProviderLocationTotal PaymentsStatus
Clinical Pathology Laboratories, Inc.Austin, TX$541.0M⚠️ Flagged
Quest Diagnostics Clinical Laboratories IncIrving, TX$453.2M⚠️ Flagged
Laboratory Corporation Of AmericaDallas, TX$389.6M⚠️ Flagged
Quest Diagnostics Clinical Laboratories IncHouston, TX$311.2M⚠️ Flagged
Laboratory Corporation Of AmericaHouston, TX$299.4M⚠️ Flagged

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Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • National Plan and Provider Enumeration System (NPPES)

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.

Believe this data is inaccurate? Dispute this data