Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or New Mexico for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to New Mexico only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. New Mexico (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Tricore Reference Laboratories (NPI 1033285044)

Key Findings

Field	Value
Entity Type	Organization
Organization	Tricore Reference Laboratories
Address	1001 Woodward Pl Ne
City	Albuquerque
State	NM
ZIP	87102
Taxonomy	Clinical Medical Laboratory
NPI Enumerated	November 28, 2006

Payer Source	Total Paid
Medicaid	$64.8M
Medicare	$0

This provider is effectively a Medicaid-focused reference laboratory: there is no Medicare billing on file and total Medicaid revenue is $64.8M. The NPI was enumerated 2006-11-28 (~20 years ago), indicating an established operation concentrated on the Medicaid payer stream rather than split between Medicare and Medicaid.

Revenue is highly concentrated in a small set of Medicaid codes: the top three Medicaid codes together account for 34.6% of this provider's total Medicaid revenue. In particular, U0003 accounts for $7.8M (18.3%), 80050 for $4.2M (9.8%), and 87491 for $2.7M (6.4%).

The code mix indicates a high-throughput reference lab that combines large-volume routine chemistry/panel work with extensive molecular infectious-disease testing. High-volume panel codes such as 80050, 80053, and 80061 sit alongside molecular and NAAT SARS-CoV-2 codes like U0003 and U0005 and multiplex respiratory tests 87633/87635, suggesting centralized processing for both routine outpatient screening and high-volume infectious-disease diagnostics.

TRICORE is a dominant statewide player for many Medicaid codes: U0003 ranks #1 of 41 providers (100th percentile; extreme outlier), 80050 ranks #1 of 33 (100th percentile; extreme outlier), and multiple other routine and molecular codes rank at or near the top statewide. These rank/percentile signals indicate volumes far above typical in-state peers across several key service lines.

The provider also performs materially higher‑complexity molecular and genomic testing alongside volume work: 87633 generated $1.5M at $395 avg paid/claim, 81420 generated $987K at $698 avg paid/claim, 87902 generated $961.8K at $258 avg paid/claim, and 81511 generated $776K at $164 avg paid/claim. Those figures point to a mixed revenue model that includes both high-unit-price specialized assays and high-volume low-unit-price panels.

Service breadth extends beyond chemistry and molecular diagnostics into toxicology and pathology: definitive drug testing G0480 produced $1.1M, presumptive drug screening 80307 produced $1.1M, surgical pathology 88305 produced $1.1M, and cytology 88175 produced $833.2K. This mix shows the lab supplies inpatient/outpatient care with confirmatory toxicology, anatomic pathology, and cytology capabilities rather than a narrow single-test focus.

Medicaid revenue sensitivity is concentrated in pandemic and high-volume outpatient testing lines: U0003 alone represents $7.8M (18.3%) and U0005 contributes $1M (2.4%), while the top three codes drive 34.6% of Medicaid revenue overall. That concentration ties a material share of revenue to testing demand and Medicaid payment for a few high-volume codes, so shifts in utilization or policy for those codes would materially affect this provider’s Medicaid receipts.

Claim volumes demonstrate exceptionally large throughput on routine testing: 80053 shows 198K claims, 80061 shows 169K claims, 83036 shows 139.8K claims, and 85025 shows 138.5K claims, reflecting an operational scale consistent with centralized reference-laboratory processing for outpatient populations. These claim counts, combined with the provider’s top-state ranks, underscore significant market share in routine lab services within the state.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

342 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…	94,100	$80	$7.8M
80050	The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the…	88,950	$50	$4.2M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	77,810	$40	$2.7M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	77,810	$40	$2.7M
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…	90,040	$30	$2.5M
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.	169,020	$10	$2.2M
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.	197,990	$10	$2M
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…	113,830	$20	$1.7M
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	3,700	$400	$1.5M
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).…	139,810	$10	$1.3M

Showing 1–10 of 342

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other New Mexico providers billing the same CPT/HCPCS codes.

Claims Volume vs. New Mexico Distribution

Tricore Reference Laboratories — 18 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

342 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	19	30	3,760	$120	$900.7K
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.	11	80	3,340	$60	$595K
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	2	10	820	$230	$553.6K
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…	1	40	880	$80	$527.4K
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	14	20	790	$240	$493.1K
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…	11	10	350	$120	$373.8K
0241U	N/A	26	30	1,080	$150	$353.2K
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	1	20	250	$410	$330.3K
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…	6	50	530	$90	$323.8K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	6	50	1,740	$60	$317.5K

Showing 1–10 of 342

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bright Horizons, Inc.	NM	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$46.9M
Lovelace Health System LLC	NM	General Acute Care Hospital	$0	$45.2M
App Of New Mexico Ed PLLC	NM	Emergency Medicine Physician	$0	$42M
Duke City Recovery Toolbox LLC	NM	Community/Behavioral Health Agency	$108.4K	$28M
Metro Treatment Of New Mexico LP	NM	Methadone Clinic	$220.4K	$27.9M
Enchanted Care Solutions, LLC	NM	Home Health Agency	$0	$25.8M
Open Skies Healthcare	NM	Community/Behavioral Health Agency	$0	$23.8M
Krossroads Integrative Health And Recovery Solutions Inc	NM	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$16.7M
Behavioral Healthcare Services, Inc.	NM	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$14.8M
Hopeworks	NM	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$13.4M

Tricore Reference Laboratories — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References