Statistical flag only — not an accusation of fraud
This provider's $34.8M in total Medicare payments ranks in the 97th percentile of Clinical Laboratory providers nationally.
Their average markup ratio of 5.61x is significantly above the specialty median of 3.7x.
Medicare payments to this provider grew 115% from 2014 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.
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 | $57.56 | $10.39 | 5.54x | $47.17 | $2.4M | 227.6K | 59 |
| 2015 | $58.32 | $11.06 | 5.27x | $47.26 | $3.1M | 279.5K | 59 |
| 2016 | $58.74 | $11.28 | 5.21x | $47.46 | $3.1M | 272.9K | 57 |
| 2017 | $59.08 | $11.32 | 5.22x | $47.76 | $3.1M | 271.7K | 63 |
| 2018 | $59.91 | $11.24 | 5.33x | $48.67 | $3.1M | 272.6K | 65 |
| 2019 | $60.69 | $10.73 | 5.66x | $49.96 | $2.9M | 272.7K | 65 |
| 2020 | $61.30 | $10.28 | 5.96x | $51.02 | $3.7M | 363.3K | 67 |
| 2021 | $63.04 | $10.51 | 6.00x | $52.53 | $4.2M | 402.1K | 88 |
| 2022 | $63.08 | $10.55 | 5.98x | $52.53 | $4.2M | 395.6K | 124 |
| 2023 | $63.60 | $11.39 | 5.58x | $52.21 | $5.1M | 446.5K | 133 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| P9604 | Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge | 585.3K | $11.7M | $20.03 | 1.80x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 287.7K | $2.5M | $8.78 | 5.58x |
| 36415 | Insertion of needle into vein for collection of blood sample | 585.3K | $2.1M | $3.57 | 14.00x |
| 84443 | Blood test, thyroid stimulating hormone (tsh) | 86.8K | $1.6M | $18.59 | 8.05x |
| 82306 | Vitamin d-3 level | 49.0K | $1.6M | $32.66 | 4.13x |
| 80048 | Blood test, basic group of blood chemicals (calcium, total) | 173.7K | $1.5M | $8.79 | 7.96x |
| 80053 | Blood test, comprehensive group of blood chemicals | 110.7K | $1.3M | $11.95 | 7.45x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 80.0K | $1.0M | $12.94 | 5.79x |
| 83880 | Natriuretic peptide (heart and blood vessel protein) level | 25.2K | $1.0M | $41.04 | 3.29x |
| 87086 | Bacterial colony count, urine | 101.9K | $927.9K | $9.11 | 5.05x |
| 80076 | Liver function blood test panel | 101.7K | $807.6K | $7.94 | 9.07x |
| 85610 | Blood test, clotting time | 161.2K | $785.7K | $4.87 | 15.38x |
| 83036 | Hemoglobin a1c level | 69.6K | $736.4K | $10.59 | 8.31x |
| 82607 | Cyanocobalamin (vitamin b-12) level | 33.1K | $535.1K | $16.17 | 4.95x |
| 82728 | Ferritin (blood protein) level | 30.8K | $461.9K | $14.98 | 4.64x |
| 87184 | Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral) | 54.9K | $446.8K | $8.14 | 5.65x |
| 81001 | Manual urinalysis test with examination using microscope, automated | 123.5K | $440.9K | $3.57 | 11.21x |
| 83970 | Parathormone (parathyroid hormone) level | 9.1K | $417.5K | $45.70 | 2.38x |
| 84439 | Thyroxine (thyroid chemical), free | 33.5K | $326.2K | $9.74 | 8.42x |
| 83735 | Magnesium level | 43.0K | $321.8K | $7.48 | 8.69x |
This provider submits charges 5.61 times higher than what Medicare actually pays.
A markup ratio of 5.61x means for every $100 Medicare pays, this provider initially charges $561. 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 CA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Genomic Health, Inc. | Redwood City, CA | $887.6M | ✓ Clear |
| Unilab Corporation | West Hills, CA | $868.8M | ⚠️ Flagged |
| Caredx Inc. | Brisbane, CA | $751.0M | ✓ Clear |
| Laboratory Corporation Of America | San Diego, CA | $592.4M | ⚠️ Flagged |
| Millennium Health, Llc | San Diego, CA | $587.9M | ✓ 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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