Our Data & Sources
Every number on GougeStop comes from public federal data or peer-reviewed research.
⚠ Original Medicare Only
All rates and charge data on this site apply to Original Medicare (also called Traditional Medicare or Medicare Fee-for-Service — Parts A and B), administered directly by the federal government.
Both datasets we use are Original Medicare only. Medicare Advantage plans (Part C) are administered by private insurers who submit claims to those insurers — not to CMS — so that data is not publicly available. This means both the Medicare rates and the lab charge ranges shown here reflect Original Medicare transactions only.
If you are enrolled in a Medicare Advantage plan (Part C), your coverage rules, rates, and cost-sharing may differ. Contact your plan directly. Not sure which you have? If your card shows a private insurer's name (Humana, UnitedHealthcare, Aetna, BCBS, etc.) or says “Medicare Advantage” or “Part C,” you have a Medicare Advantage plan.
Where Our Numbers Come From
GougeStop uses two data sets published by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare:
1. Clinical Laboratory Fee Schedule (CLFS)
What Medicare pays for each lab test — the official reimbursement rate. CMS sets and publishes this annually. Our app pulls it live so the rates always reflect the current year.
Source: Centers for Medicare & Medicaid Services, Clinical Laboratory Fee Schedule (CLFS)2. Medicare Provider Utilization and Payment Data (Part B)
What providers actually billed on Medicare claims — the “sticker price.” CMS collects this from every Original Medicare claim submitted nationwide. The most recent release covers 2023 claims. Our charge ranges come from this data: 97,714 lab-charge records across 20 common tests, shown as the 1st–99th percentile so no single outlier skews the picture.
Source: Centers for Medicare & Medicaid Services, Medicare Provider Utilization and Payment Data, Part B (2023)Site-Wide Statistics
| Figure | Source | Notes |
|---|---|---|
| 392% average markup above Medicare across common lab tests | CMS Part B 2023 claims data — GougeStop analysis | Mean markup across 97,714 records: 391.8% (median 250%). Rounded to 392% site-wide. |
| Markups shown as “up to 2,000%+” on some tests | Display rule | Real values can exceed 2,000%; capped for readability. Only urinalysis reaches the cap. |
Per-Test Data
Medicare rates are current (2026 CLFS). Charge ranges are 2023 public data (1st–99th percentile). Markup is computed from both and shown as an “up to” value.
| Test | Medicare Rate | Labs Billed (2023) | Markup |
|---|---|---|---|
| Basic Metabolic Panel | $8.46 | $8–$134 | up to 1,484% |
| Comprehensive Metabolic Panel | $10.56 | $10–$153 | up to 1,349% |
| Lipid Panel | $13.39 | $13–$182 | up to 1,259% |
| Hepatic Function Panel | $8.17 | $8–$136 | up to 1,565% |
| Urinalysis, Automated | $2.25 | $2–$56 | up to 2,000%+ |
| Vitamin D, 25-Hydroxy | $29.60 | $29–$358 | up to 1,109% |
| CK / CPK | $6.51 | $7–$104 | up to 1,498% |
| Vitamin B12 | $15.08 | $15–$221 | up to 1,366% |
| Ferritin | $13.63 | $14–$201 | up to 1,375% |
| Folate | $14.70 | $15–$222 | up to 1,410% |
| Glucose, Blood | $3.93 | $4–$59 | up to 1,401% |
| Hemoglobin A1c | $9.71 | $9–$137 | up to 1,311% |
| Magnesium | $6.70 | $7–$122 | up to 1,721% |
| PSA | $18.39 | $18–$225 | up to 1,123% |
| Testosterone, Total | $25.81 | $26–$344 | up to 1,233% |
| TSH | $16.80 | $16–$203 | up to 1,108% |
| T3, Total | $14.18 | $14–$194 | up to 1,268% |
| CBC with Differential | $7.77 | $8–$106 | up to 1,264% |
| CBC without Differential | $6.47 | $6–$87 | up to 1,245% |
| C-Reactive Protein | $5.18 | $5–$106 | up to 1,946% |
Statistics from Our Blog Posts
| Figure | Blog Post | Source |
|---|---|---|
| 80%+ of medical bills contain at least one error | 5 Things to Know | Pat Palmer / Medical Billing Advocates of America via Healthline |
| 53% of Medicare complainants said the billed amount was inaccurate | 5 Things to Know | CFPB Issue Spotlight, May 2023 |
| ~75% who contacted a billing office had the error corrected | 5 Things to Know | JAMA Health Forum 2024 via NBC News |
| CBC hospital avg $401 vs Medicare $7.77; CMP $957 vs Medicare $14.35 | 5 Things to Know | Cureus/PMC 2024 — 42 Florida hospitals |
| >80% of appealed Medicare Advantage claims overturned, 2019–2024 | 5 Things to Know | KFF, January 2026 + Counterforce Health |
| 76% who negotiated got help or had the bill reduced or canceled | 5 Things to Know | JAMA Health Forum 2024 via NBC News |
| Cash prices varied up to 243× between Tennessee hospitals | 5 Things to Know | JALM, February 2025 |
| ABN = Form CMS-R-131; no valid ABN means provider is liable | ABN Trap | Centers for Medicare & Medicaid Services; Center for Medicare Advocacy |
| Providers often willing to negotiate, discount, or set up payment plans | ABN Trap | Solace Health |
A Note on Data Currency
Medicare rates in our app update automatically whenever CMS changes the Clinical Laboratory Fee Schedule — you’re always seeing the current rate. Lab charge ranges reflect the most recent public CMS claims data (2023). When CMS releases newer charge data we’ll update; until then, our Find a Lab tool (via MedCarePrecheck, our affiliate site) links to current lab pricing.
Last updated: June 2026.