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NPI 1144202003 · Hillside, IL · Clinical Medical Laboratory
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Medstar Laboratory, Inc is a clinical medical laboratory provider located in Hillside, Illinois. This profile covers 161 Medicare and 163 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Medstar Laboratory, Inc |
| Address | 4531 Harrison St |
| City | Hillside |
| State | IL |
| ZIP | 60162 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | November 16, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $37.3M |
| Medicare | $2.8M |
Payer mix is heavily Medicaid-centric: Total Medicare revenue is $2.8M while Total Medicaid revenue is $37.3M, making Medicaid the dominant payer by a wide margin for this provider. The provider is effectively a Medicaid-first laboratory in scale, though it retains a meaningful Medicare footprint.
The NPI was enumerated on 2005-11-16 (~21 years ago), indicating the lab has been an established participant in fee-for-service billing for two decades. This tenure supports the pattern of sustained high-volume activity across routine chemistry, hematology, and infectious disease testing.
Medicare top-line services are routine ambulatory lab tests and specimen collection: the top three Medicare revenue drivers are 82306 ($289.9K), 84443 ($226.6K), and 80061 ($205.2K), and these three codes together account for 33.0% of Medicare revenue. The Medicare code mix (vitamin D, TSH, lipid panel) plus a large P9603 travel allowance (162.7K claims, $162.7K revenue) suggests a combination of high-throughput analytic testing and substantial specimen-collection activity (including home- or nursing-home draws).
Despite modest absolute Medicare revenue, the provider posts high national ranks on many Medicare codes: the top Medicare codes (82306, 84443, 80061) are in the 99th percentile nationally but are characterized in the data as typical or unremarkable volume for those codes. This pattern suggests broad-market participation at scale rather than a narrowly concentrated national market dominance for specialized testing.
Medicaid revenue is concentrated but also shows pronounced state-market dominance for several assays: the top three Medicaid codes — 84443 ($2.7M), 87591 ($2.6M), and 87491 ($2.6M) — account for 28.3% of Medicaid revenue. Notably, 84443 is flagged as an extreme outlier, far above typical state volume (rank #3, 100th percentile), while the STI NAATs 87591 and 87491 are very high-volume (99th percentile) and drive substantial Medicaid revenue.
The provider is a major statewide competitor on many Medicaid codes: multiple tests are labeled extreme outlier or top-ranked in Illinois (for example, 84436 ranks #1 of 78 and 86703 ranks #1 of 49, both 100th percentile extreme outliers). This concentration of top state ranks across immunoassays, viral serologies, and thyroid testing indicates the lab is a dominant Medicaid service provider for a broad set of routine and public-health-related assays.
Public-health and infectious-disease testing comprises a significant share of activity across payers: Medicaid U0004 (24K claims, $1.7M revenue, 5.9% of Medicaid revenue) and Medicare U0004 ($80.7K, 3.7% of Medicare revenue) show substantial COVID testing volume, and high Medicaid volumes for G2023, 80074, 86704, and HIV/hepatitis panels point to heavy infectious-disease screening and surveillance work. This mix implies contracts or referrals tied to community screening, STI programs, and pandemic response.
Operational footprint appears high-throughput and broad-based: very large claim counts for core panels (e.g., Medicaid 80053 231.7K claims, Medicare 80053 17.9K claims; Medicaid 85025 259.5K claims) plus many chemistry and hematology codes indicate routine outpatient and public-health specimen processing at scale. Coupled with large specimen-collection activity (Medicare P9603 162.7K claims), the data are consistent with a laboratory serving multiple clinics, public programs, and community collection sites rather than a narrow specialty reference niche.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
161 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 10,000 | $30 | $289.9K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 14,160 | $20 | $226.6K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 15,780 | $10 | $205.2K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 17,880 | $10 | $178.8K |
| P9603 | Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled | 162,710 | $1 | $162.7K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 17,140 | $10 | $137.1K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 12,670 | $10 | $126.7K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 13,410 | $10 | $107.3K |
| 82607 | The lab analyst performs a test to measure the amount of vitamin B12 in a patient specimen, typically in patient blood. | 6,980 | $20 | $104.7K |
| U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by… | 1,090 | $70 | $80.7K |
Showing 1–10 of 161
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 161 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
161 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| U0004 | 7 | 20 | 530 | $70 | $383.5K |
| P9603 | 12 | 40 | 35,960 | $1 | $232.2K |
| 87798 | 64 | 70 | 750 | $30 | $172.3K |
| G0471 | 4 | 10 | 940 | $10 | $166.2K |
| 81513 | 4 | 10 | 80 | $140 | $118.9K |
| G2023 | 31 | 90 | 400 | $20 | $96.5K |
| U0005 | 32 | 100 | 270 | $20 | $86.3K |
| 82652 | 3 | 10 | 1,390 | $40 | $69.6K |
| 87481 | 43 | 60 | 120 | $30 | $47.3K |
| 88305 | 541 | 580 | 610 | $30 | $38.2K |
Showing 1–10 of 161
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
163 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 193,940 | $10 | $2.7M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 69,400 | $40 | $2.6M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 68,340 | $40 | $2.6M |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 231,680 | $10 | $2.1M |
| 80074 | The lab analyst performs an acute hepatitis panel; the panel must include tests for hepatitis A IgM antibody, hepatitis B core IgM antibody, hepatitis B surface antigen, and hepatitis C antibody. | 60,910 | $30 | $2M |
| U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by… | 24,040 | $70 | $1.7M |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 59,110 | $30 | $1.5M |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 259,450 | $10 | $1.3M |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 29,080 | $40 | $1.2M |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 227,460 | $10 | $1.1M |
Showing 1–10 of 163
How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Illinois median
163 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81513 | The lab analyst performs the technical lab test on a vaginal fluid specimen for quantitative real–time amplification of RNA markers for three bacterial species listed in the code descriptor, and… | 4 | 10 | 210 | $70 | $1.4M |
| U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by… | 7 | 50 | 710 | $70 | $1.2M |
| 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… | 20 | 70 | 570 | $50 | $565.6K |
| G0481 | 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… | 12 | 30 | 420 | $70 | $308.4K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 8 | 280 | 1,120 | $30 | $218.9K |
| 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,… | 26 | 210 | 680 | $20 | $206.4K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 17 | 250 | 450 | $40 | $185.7K |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 6 | 110 | 150 | $40 | $184.1K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 4 | 360 | 600 | $30 | $165.1K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 4 | 360 | 630 | $30 | $165K |
Showing 1–10 of 163
Other providers in the same ZIP code as Medstar Laboratory, Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Village Of Hillside | IL | Land Ambulance | $141.1K | $3.8M |
| Samir Bhalla | IL | Geriatric Medicine (Internal Medicine) Physician | $258.1K | $1M |
| Soft Landing Labs Ltd | IL | Clinical Medical Laboratory | $256.1K | $782.1K |
| Sunto Yen | IL | Rehabilitation Practitioner | $478.3K | $207.3K |
| United Rx LLC | IL | Long Term Care Pharmacy | $10.1K | $0 |
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