Statistical flag only — not an accusation of fraud
This provider's $10.0M in total Medicare payments ranks in the 90th percentile of Clinical Laboratory providers nationally.
Medicare payments to this provider grew 127% from 2022 to 2023.
This provider has been statistically flagged with a risk score of 71/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 127% in 2023
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 |
|---|---|---|---|---|---|---|---|
| 2022 | $56.17 | $12.70 | 4.42x | $43.47 | $3.1M | 241.2K | 177 |
| 2023 | $56.10 | $13.09 | 4.29x | $43.01 | $7.0M | 532.2K | 224 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 80053 | Blood test, comprehensive group of blood chemicals | 87.3K | $903.0K | $10.35 | 4.48x |
| 84443 | Blood test, thyroid stimulating hormone (tsh) | 40.0K | $658.2K | $16.46 | 3.59x |
| 36415 | Insertion of needle into vein for collection of blood sample | 96.6K | $646.3K | $6.69 | 1.58x |
| 82306 | Vitamin d-3 level | 21.0K | $610.4K | $29.01 | 3.03x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 14.2K | $580.4K | $40.90 | 5.63x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 41.9K | $549.2K | $13.12 | 3.25x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 69.9K | $531.9K | $7.61 | 5.47x |
| 83970 | Parathormone (parathyroid hormone) level | 7.7K | $310.0K | $40.45 | 2.04x |
| 83036 | Hemoglobin a1c level | 24.6K | $233.8K | $9.52 | 4.34x |
| 84439 | Thyroxine (thyroid chemical), free | 19.1K | $169.0K | $8.84 | 4.38x |
| 84153 | Psa (prostate specific antigen) measurement, total | 9.1K | $163.9K | $18.02 | 5.14x |
| 88341 | Special stained specimen slides to examine tissue, each additional procedure | 4.1K | $158.6K | $38.79 | 4.49x |
| 88342 | Special stained specimen slides to examine tissue, initial procedure | 2.4K | $117.3K | $48.10 | 5.91x |
| 85027 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 16.9K | $107.3K | $6.34 | 3.58x |
| 83521 | Measurement of immunoglobulin light chains | 6.1K | $103.9K | $16.92 | 7.06x |
| 84403 | Testosterone (hormone) level, total | 4.1K | $102.6K | $25.28 | 3.70x |
| 83880 | Natriuretic peptide (heart and blood vessel protein) level | 2.6K | $98.1K | $38.47 | 2.91x |
| 84481 | Thyroid hormone, t3 measurement, free | 5.8K | $95.8K | $16.60 | 4.58x |
| 82570 | Creatinine level to test for kidney function or muscle injury | 18.5K | $94.1K | $5.08 | 7.66x |
| 88307 | Pathology examination of tissue using a microscope, moderately high complexity | 1.1K | $94.0K | $83.15 | 2.81x |
This provider submits charges 4.33 times higher than what Medicare actually pays.
A markup ratio of 4.33x means for every $100 Medicare pays, this provider initially charges $433. This is higher than the national average.
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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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