Exact Sciences Laboratories LLC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $282.63 per claim for 81528 (Oncology, colorectal screening, quantitative analysis of stool DNA), which is 20.6× the national median of $13.70.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: 81528 at 20.6× median, U0003 at 1.6× median.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Advanced Detection Signals
Additional statistical tests from advanced fraud detection methods
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Bills $282.63 per claim for 81528 (Oncology, colorectal screening, quantitative analysis of stool DNA) — 20.6× the national median of $13.70.
Billing in the top 1% nationally for 1 procedure code: 81528.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinical Medical Laboratory Peers
Total spending distribution among 88 providers in this specialty
This provider's total spending of $276.5M is at the 75th percentile among 88 Clinical Medical Laboratory providers.
Total Paid
$276.5M
$276,545,732
Total Claims
983K
Beneficiaries
926K
1.1 claims/patient
Avg Cost/Claim
$281
#283 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Exact Sciences Laboratories LLC is a Clinical Medical Laboratory provider based in Madison, WI. From the 2018–2024 period, this provider received $276.5M in Medicaid payments across 983K claims.
Why This Matters
This provider received $276.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 34,568 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 30 distinct procedure codes. The top code (81528 (Oncology, colorectal screening, quantitative analysis of stool DNA)) accounts for 100% of total spending.
$276.2M
977K claims
$282.63
$13.70
Oncology, colorectal screening, quantitative analysis of stool DNA
$276.2M
977K claims · 99.9%
$113K
2K claims
$56.33
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$113K
2K claims · 0.0%
$93K
1K claims
$79.77
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$93K
1K claims · 0.0%
$32K
221 claims
$142.63
$91.47
Proprietary lab analysis, genomic sequencing
$32K
221 claims · 0.0%
$22K
261 claims
$84.30
$57.85
Office/outpatient visit, new patient, low-mod complexity
$22K
261 claims · 0.0%
$11K
88 claims
$128.18
$84.03
Office/outpatient visit, new patient, mod-high complexity
$11K
88 claims · 0.0%
$11K
108 claims
$98.55
$63.08
Infectious disease detection (COVID-19)
$11K
108 claims · 0.0%
$7K
196 claims
$33.43
$17.85
Immunization administration, first vaccine/toxoid, with counseling
$7K
196 claims · 0.0%
$5K
57 claims
$88.74
$80.15
Preventive medicine, established patient, age 12-17
$5K
57 claims · 0.0%
$4K
47 claims
$80.48
$74.82
Preventive medicine, established patient, age 5-11
$4K
47 claims · 0.0%
$4K
361 claims
$10.18
$9.10
Developmental screening, per standardized instrument
$4K
361 claims · 0.0%
$3K
383 claims · 0.0%
$3K
73 claims
$47.05
$36.13
Debridement, subcutaneous tissue, first 20 sq cm
$3K
73 claims · 0.0%
$3K
41 claims
$75.09
$35.89
Diabetes self-management training, individual
$3K
41 claims · 0.0%
$3K
206 claims
$12.43
$11.48
Streptococcus, Group A, rapid antigen detection
$3K
206 claims · 0.0%
$2K
28 claims
$81.81
$75.18
Preventive medicine, established patient, age 1-4
$2K
28 claims · 0.0%
$1K
91 claims
$13.33
$9.70
Electrocardiogram, complete, with interpretation and report
$1K
91 claims · 0.0%
$1K
12 claims
$99.00
$76.06
Preventive medicine, established patient, age 40-64
$1K
12 claims · 0.0%
$1K
12 claims
$93.08
$72.71
Preventive medicine, established patient, age 18-39
$1K
12 claims · 0.0%
$1K
13 claims
$85.44
$74.09
Office/outpatient visit, high complexity
$1K
13 claims · 0.0%
$1K
60 claims
$17.22
$9.80
Immunization administration, 1 vaccine, percutaneous/ID/SC/IM
$1K
60 claims · 0.0%
Chest X-ray, 2 views
$970
55 claims · 0.0%
$914
12 claims
$76.21
$69.35
Preventive medicine, established patient, infant (under 1)
$914
12 claims · 0.0%
$903
17 claims
$53.13
$29.03
Arthrocentesis, aspiration/injection, major joint
$903
17 claims · 0.0%
$890
14 claims
$63.59
$39.63
SARS-CoV-2 COVID-19 antigen detection, immunoassay, each
$890
14 claims · 0.0%
$753
75 claims · 0.0%
$739
35 claims
$21.11
$13.55
X-ray of ankle, complete, minimum three views
$739
35 claims · 0.0%
$733
13 claims
$56.38
$54.68
Echocardiography, transthoracic, complete, with Doppler
$733
13 claims · 0.0%
$713
15 claims
$47.54
$24.33
Medical nutrition therapy, reassessment, group, thirty minutes
$713
15 claims · 0.0%
$553
21 claims · 0.0%
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