Statistical flag only — not an accusation of fraud
This provider's $221.3M in total Medicare payments ranks in the 99th percentile of Clinical Laboratory providers nationally.
Their average markup ratio of 5.76x is significantly above the specialty median of 3.7x.
This provider has been statistically flagged with a risk score of 79/100. 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 | $64.95 | $12.58 | 5.16x | $52.37 | $21.2M | 1.7M | 311 |
| 2015 | $67.66 | $13.01 | 5.20x | $54.65 | $21.0M | 1.6M | 304 |
| 2016 | $70.83 | $13.64 | 5.19x | $57.19 | $22.2M | 1.6M | 321 |
| 2017 | $71.27 | $13.82 | 5.16x | $57.45 | $23.2M | 1.7M | 332 |
| 2018 | $71.62 | $13.53 | 5.29x | $58.09 | $23.6M | 1.7M | 335 |
| 2019 | $73.82 | $12.68 | 5.82x | $61.14 | $20.9M | 1.6M | 324 |
| 2020 | $86.75 | $14.07 | 6.17x | $72.68 | $21.1M | 1.5M | 313 |
| 2021 | $87.42 | $14.48 | 6.04x | $72.94 | $25.3M | 1.7M | 323 |
| 2022 | $91.15 | $14.48 | 6.29x | $76.67 | $23.7M | 1.6M | 328 |
| 2023 | $93.54 | $12.53 | 7.47x | $81.01 | $19.0M | 1.5M | 323 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 1.3M | $19.9M | $15.00 | 6.45x |
| 84443 | Blood test, thyroid stimulating hormone (tsh) | 890.9K | $17.5M | $19.61 | 4.79x |
| 80053 | Blood test, comprehensive group of blood chemicals | 1.6M | $17.4M | $10.64 | 5.51x |
| 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 | 161.3K | $13.1M | $81.34 | 1.63x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 1.4M | $12.3M | $9.05 | 5.49x |
| 82306 | Vitamin d-3 level | 340.9K | $11.5M | $33.83 | 5.80x |
| 83036 | Hemoglobin a1c level | 859.2K | $9.7M | $11.26 | 6.35x |
| 80048 | Blood test, basic group of blood chemicals (calcium, total) | 598.0K | $5.5M | $9.19 | 5.93x |
| 83970 | Parathormone (parathyroid hormone) level | 114.6K | $5.4M | $47.42 | 5.17x |
| 84153 | Psa (prostate specific antigen) measurement, total | 180.7K | $3.9M | $21.33 | 4.96x |
| 83880 | Natriuretic peptide (heart and blood vessel protein) level | 94.9K | $3.8M | $40.27 | 4.02x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 151.4K | $3.5M | $23.07 | 6.27x |
| 36415 | Insertion of needle into vein for collection of blood sample | 1.1M | $3.4M | $3.13 | 8.33x |
| 82607 | Cyanocobalamin (vitamin b-12) level | 198.8K | $3.4M | $17.28 | 7.12x |
| 87086 | Bacterial colony count, urine | 349.8K | $3.3M | $9.49 | 8.94x |
| U0005 | 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, cdc or non-cdc, making use of high throughput technologies, completed within | 117.9K | $2.9M | $24.85 | 1.64x |
| 82043 | Urine microalbumin (protein) level | 379.2K | $2.5M | $6.66 | 15.26x |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | 118.1K | $2.5M | $21.37 | 6.11x |
| 87186 | Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution | 215.3K | $2.2M | $10.30 | 8.67x |
| G0472 | Hepatitis c antibody screening, for individual at high risk and other covered indication(s) | 60.1K | $2.2M | $36.80 | 3.89x |
This provider submits charges 5.76 times higher than what Medicare actually pays.
A markup ratio of 5.76x means for every $100 Medicare pays, this provider initially charges $576. 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 WI for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Exact Sciences Laboratories, Llc | Madison, WI | $1.6B | ⚠️ Flagged |
| Marshfield Clinic Inc | Marshfield, WI | $44.5M | ✓ Clear |
| Wisconsin Diagnostic Laboratories Llc | Milwaukee, WI | $36.3M | ✓ 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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