Statistical flag only — not an accusation of fraud
This provider's $94.2M in total Medicare payments ranks in the 99th percentile of Clinical Laboratory providers nationally.
Medicare payments to this provider grew 357% from 2020 to 2023.
This provider has been statistically flagged with a risk score of 70/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 297% in 2022
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 |
|---|---|---|---|---|---|---|---|
| 2020 | $57.15 | $47.66 | 1.20x | $9.49 | $9.2M | 192.2K | 19 |
| 2021 | $49.29 | $40.92 | 1.20x | $8.37 | $8.7M | 212.4K | 30 |
| 2022 | $45.10 | $36.75 | 1.23x | $8.35 | $34.5M | 940.0K | 30 |
| 2023 | $43.14 | $35.31 | 1.22x | $7.83 | $41.9M | 1.2M | 27 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 87798 | Detection test by nucleic acid for organism, amplified probe technique | 1.3M | $43.4M | $34.51 | 1.22x |
| 87481 | Detection test for candida species (yeast), amplified probe technique | 373.4K | $12.9M | $34.51 | 1.22x |
| 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 | 55.2K | $4.5M | $80.67 | 1.30x |
| 87653 | Detection test by nucleic acid for strep (streptococcus, group b), amplified probe technique | 98.7K | $3.4M | $34.58 | 1.22x |
| 87500 | Detection test by nucleic acid for vancomycin resistance strep (vre), amplified probe technique | 92.5K | $3.2M | $34.52 | 1.22x |
| 87641 | Detection test by nucleic acid for staphylococcus aureus, methicillin resistant (mrsa bacteria), amplified probe technique | 91.9K | $3.2M | $34.53 | 1.22x |
| 87801 | Detection test by nucleic acid for multiple organisms, amplified probe(s) technique | 32.4K | $2.3M | $70.20 | 1.20x |
| 87631 | Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets | 15.9K | $2.2M | $141.51 | 1.21x |
| 87529 | Detection test by nucleic acid for herpes simplex virus, amplified probe technique | 64.6K | $2.2M | $34.48 | 1.22x |
| 87640 | Detection test by nucleic acid for staphylococcus aureus (bacteria), amplified probe technique | 60.7K | $2.1M | $34.72 | 1.21x |
| 87651 | Detection test by nucleic acid for strep (streptococcus, group a), amplified probe technique | 41.4K | $1.4M | $34.60 | 1.22x |
| 87625 | Detection test by nucleic acid for human papillomavirus (hpv), types 16 and 18 only | 32.7K | $1.3M | $39.86 | 1.22x |
| 87563 | Detection of mycoplasma genitalium by dna or rna probe | 34.0K | $1.2M | $34.45 | 1.22x |
| 87493 | Detection test by nucleic acid for clostridium difficile, amplified probe technique | 28.9K | $1.1M | $36.55 | 1.16x |
| 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 | 40.7K | $1.0M | $24.63 | 1.04x |
| 87591 | Detection test by nucleic acid for neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique | 28.0K | $967.3K | $34.50 | 1.22x |
| 87511 | Detection test for gardnerella vaginalis (bacteria), amplified probe technique | 27.5K | $949.6K | $34.54 | 1.22x |
| 87556 | Detection test by nucleic acid for mycobacteria tuberculosis (tb bacteria), amplified probe technique | 21.2K | $866.9K | $40.90 | 1.18x |
| 87491 | Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique | 20.5K | $707.2K | $34.54 | 1.22x |
| 87581 | Detection test by nucleic acid for mycoplasma pneumoniae (bacteria), amplified probe technique | 20.0K | $694.6K | $34.80 | 1.21x |
This provider submits charges 1.22 times higher than what Medicare actually pays.
A markup ratio of 1.22x means for every $100 Medicare pays, this provider initially charges $122. 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 PA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Quest Diagnostics Clinical Laboratories Inc | Norristown, PA | $340.6M | ✓ Clear |
| Quest Diagnostics Of Pennsylvania, Inc. | Pittsburgh, PA | $130.4M | ⚠️ Flagged |
| Health Network Laboratories, Llc | Allentown, PA | $125.3M | ⚠️ Flagged |
| Sma Medical, Inc. | Feasterville, PA | $100.9M | ✓ Clear |
| Interpace Diagnostics Corporation | Pittsburgh, PA | $95.6M | ✓ 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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