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NPI 1215048913 · Eden Prairie, MN · Clinical Medical Laboratory
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Group Health, Inc. is a clinical medical laboratory provider located in Eden Prairie, Minnesota. This profile covers 312 Medicare and 169 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 | Group Health, Inc. |
| Address | 9700 W 76th St |
| City | Eden Prairie |
| State | MN |
| ZIP | 55344 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | August 31, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $11.5M |
| Medicare | $2.4M |
Payer mix is heavily weighted to Medicaid: lifetime Medicaid revenue is $11.5M compared with $2.4M in Medicare, so Medicaid accounts for the bulk of this lab’s billed activity and revenue. This makes the provider effectively Medicaid-focused at scale rather than Medicare-driven.
The provider’s Clinical Medical Laboratory taxonomy and code mix show a full-service diagnostic lab offering high-volume routine chemistry and chronic-disease monitoring tests (80048, 80061, 80053, 83036) alongside extensive infectious disease and sexual health testing (U0003, 87491, 87591, 87389). High claim counts across both panel chemistry and molecular/NAAT codes indicate operations that serve both primary-care screening and high-throughput public-health/molecular testing workflows.
Revenue concentration differs by payer: the top three Medicare codes account for 29.9% of Medicare revenue, while the top three Medicaid codes account for 43.1% of Medicaid revenue. The larger share concentrated in Medicaid suggests the provider’s Medicaid business is more dependent on a small set of high-volume tests than its Medicare book.
On Medicare the practice shows national high-volume strength for specific chemistry and diabetes monitoring tests: 80048 is listed as an "extreme outlier, far above typical national volume for this code" and 83036 ranks at the 100th percentile ("notably above typical national volume"). At the same time several commonly reimbursed Medicare codes (80061, 84443 and many others) are in the 99th percentile but described as "typical, unremarkable volume," indicating strong absolute volumes for routine lab work but only a few standout outlier codes.
In Medicaid (in-state) the provider is a dominant performer for multiple public-health and STI screening tests: U0003 is large ($2.3M, 26.2% of Medicaid revenue) and ranks in the 97th percentile ("notably above typical state volume"), 87491 and 87591 rank #4 in-state and are described as "extreme outlier, far above typical state volume," and 86481 ranks #1 in-state ("extreme outlier"). These rankings and labels collectively characterize the provider as a major statewide player for COVID, STI, TB, and HIV testing.
COVID testing contributes very different proportions across payers: U0003 on Medicaid shows 33.6K claims and $2.3M revenue (26.2% of this provider's total Medicaid revenue), whereas U0003 on Medicare is 863 claims and $62.1K revenue (4.2% of Medicare revenue). That disparity indicates COVID/molecular NAAT work is a central revenue driver in the provider’s Medicaid business but a modest component of its Medicare mix.
The lab’s service breadth includes definitive and presumptive toxicology (G0482 on Medicare; G0480 and 80307 on Medicaid), specialized multiplex pathogen panels (87507, 87506, 87801), and high-volume screening tests (A1C 83036, vitamin D 82306). Presence of both instrumented presumptive screens and higher-complexity definitive tests suggests in-house capability for both rapid screening and confirmatory testing workflows, supporting contracts across clinical, public-health, and possibly correctional or community programs.
NPI tenure is long: the provider was enumerated on 2006-08-31 (~20 years ago), indicating an established lab operator. Long-standing enrollment paired with the high in-state rankings on many Medicaid codes suggests durable relationships with state payers and sustained operational capacity for high-volume testing services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
312 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 11,900 | $10 | $154.7K |
| 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… | 9,120 | $20 | $146K |
| 80048 | The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood… | 17,190 | $10 | $137.5K |
| 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).… | 15,240 | $10 | $137.2K |
| 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. | 8,320 | $10 | $83.2K |
| 83970 | Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function. | 1,920 | $40 | $76.9K |
| 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… | 2,440 | $30 | $68.4K |
| 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… | 860 | $70 | $62.1K |
| 82607 | The lab analyst performs a test to measure the amount of vitamin B12 in a patient specimen, typically in patient blood. | 3,920 | $20 | $58.8K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 990 | $50 | $48.3K |
Showing 1–10 of 312
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 312 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
169 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 33,640 | $70 | $2.3M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 24,310 | $30 | $753.5K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 24,070 | $30 | $746.3K |
| 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,… | 24,970 | $20 | $524.4K |
| 86481 | The lab analyst performs a test to evaluate an antigen response to certain tuberculosis (TB) antibodies by enumerating T cells that produce gamma interferon. | 5,000 | $90 | $469.8K |
| 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… | 21,220 | $20 | $466.9K |
| 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… | 35,910 | $10 | $395K |
| 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. | 7,340 | $50 | $389.2K |
| 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).… | 53,700 | $10 | $322.2K |
| 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… | 14,940 | $20 | $313.6K |
Showing 1–10 of 169
How this provider's Medicaid billing volume and revenue compare to other Minnesota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Minnesota median
169 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| G0482 | 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… | 11 | 10 | 2,200 | $120 | $1.3M |
| 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… | 7 | 30 | 340 | $60 | $890.4K |
| 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. | 20 | 100 | 510 | $40 | $560.8K |
| 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… | 8 | 270 | 550 | $70 | $254.7K |
| X5622 | N/A | 159 | 300 | 470 | $60 | $159.8K |
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 12 | 30 | 110 | $120 | $144.5K |
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 3 | 10 | 530 | $40 | $79.7K |
| 86481 | The lab analyst performs a test to evaluate an antigen response to certain tuberculosis (TB) antibodies by enumerating T cells that produce gamma interferon. | 1 | 20 | 240 | $90 | $73.9K |
| 87506 | The lab analyst performs a test to detect six to eleven types or subtypes of a pathogen, such as Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia, that cause gastrointestinal… | 4 | 10 | 490 | $200 | $70.7K |
| 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,… | 8 | 200 | 530 | $20 | $68.6K |
Showing 1–10 of 169
Other providers in the same ZIP code as Group Health, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Ear Professionals International LLC | MN | Hearing Aid Equipment | $0 | $32.4M |
| Optumrx, Inc. | MN | Durable Medical Equipment & Medical Supplies | $0 | $18.5M |
| Psi Pride Institute Inc | MN | Substance Abuse Rehabilitation Facility | $0 | $15.6M |
| Pioneer Care LLC | MN | Assisted Living Facility | $0 | $13.9M |
| Consulting Radiologists, Ltd | MN | Diagnostic Radiology Physician | $0 | $10.3M |
| Sidky Family Dentistry | MN | General Practice Dentistry | $0 | $6.3M |
| Taylor Jordan | MN | Diagnostic Radiology Physician | $545.8K | $0 |
| Ann Marie Equio | MN | Family Nurse Practitioner | $512.2K | $0 |
| Shawn Ahmed | MN | Diagnostic Radiology Physician | $505K | $0 |
| David Winger | MN | Diagnostic Radiology Physician | $413.8K | $1.6K |
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