Statistical flag only — not an accusation of fraud
This provider's $18.7M in total Medicare payments ranks in the 95th percentile of Clinical Laboratory providers nationally.
Their average markup ratio of 5.14x is significantly above the specialty median of 3.7x.
Medicare payments to this provider grew 73% from 2019 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 88% in 2020
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 |
|---|---|---|---|---|---|---|---|
| 2019 | $54.92 | $11.73 | 4.68x | $43.19 | $2.3M | 192.3K | 123 |
| 2020 | $54.91 | $10.90 | 5.04x | $44.01 | $4.2M | 388.4K | 152 |
| 2021 | $55.37 | $11.05 | 5.01x | $44.32 | $4.6M | 413.1K | 150 |
| 2022 | $54.60 | $10.06 | 5.43x | $44.54 | $3.8M | 376.2K | 140 |
| 2023 | $57.16 | $10.65 | 5.37x | $46.51 | $3.9M | 366.5K | 132 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 80053 | Blood test, comprehensive group of blood chemicals | 225.9K | $2.4M | $10.57 | 5.24x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 155.7K | $2.1M | $13.40 | 4.14x |
| 84443 | Blood test, thyroid stimulating hormone (tsh) | 110.3K | $1.9M | $16.81 | 3.64x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 136.7K | $1.1M | $7.77 | 7.65x |
| 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 | 7.8K | $884.6K | $113.59 | 1.42x |
| 80048 | Blood test, basic group of blood chemicals (calcium, total) | 92.7K | $785.5K | $8.48 | 5.35x |
| 36415 | Insertion of needle into vein for collection of blood sample | 173.1K | $702.7K | $4.06 | 5.08x |
| 83036 | Hemoglobin a1c level | 58.2K | $565.9K | $9.72 | 5.34x |
| 83880 | Natriuretic peptide (heart and blood vessel protein) level | 14.4K | $560.9K | $38.84 | 4.06x |
| 84153 | Psa (prostate specific antigen) measurement, total | 29.4K | $541.5K | $18.39 | 4.40x |
| 83970 | Parathormone (parathyroid hormone) level | 12.1K | $498.6K | $41.33 | 4.02x |
| 87086 | Bacterial colony count, urine | 57.0K | $460.2K | $8.08 | 11.53x |
| G0472 | Hepatitis c antibody screening, for individual at high risk and other covered indication(s) | 10.0K | $455.4K | $45.75 | 2.00x |
| 82607 | Cyanocobalamin (vitamin b-12) level | 25.4K | $382.5K | $15.05 | 5.32x |
| 85027 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 47.6K | $308.7K | $6.49 | 6.36x |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | 16.0K | $308.0K | $19.21 | 4.30x |
| 87186 | Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution | 32.8K | $284.4K | $8.67 | 8.69x |
| 83735 | Magnesium level | 39.1K | $262.1K | $6.70 | 6.16x |
| 84439 | Thyroxine (thyroid chemical), free | 21.7K | $196.1K | $9.03 | 5.32x |
| 82728 | Ferritin (blood protein) level | 14.3K | $195.2K | $13.63 | 5.77x |
This provider submits charges 5.14 times higher than what Medicare actually pays.
A markup ratio of 5.14x means for every $100 Medicare pays, this provider initially charges $514. 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 VA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Rca Laboratory Services, Llc | Glen Allen, VA | $76.0M | ✓ Clear |
| Quest Diagnostics Nichols Institute, Inc. | Chantilly, VA | $37.8M | ✓ Clear |
| Vista Clinical Diagnostics Llc | Danville, VA | $35.2M | ✓ 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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