Loading...
NPI 1538105366 · Phoenix, AZ · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Sonora Quest Laboratories LLC is a clinical medical laboratory provider located in Phoenix, Arizona. This profile covers 570 Medicare and 548 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 | Sonora Quest Laboratories LLC |
| Address | 424 S 56th St Ste 100 |
| City | Phoenix |
| State | AZ |
| ZIP | 85034 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | June 21, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $298.1M |
| Medicare | $57.8M |
Payer mix is heavily weighted toward Medicaid: lifetime Medicaid revenue is $298.1M versus Medicare revenue of $57.8M, so the provider operates at a materially larger scale in Medicaid than in Medicare and is effectively Medicaid-dominant in its overall billing mix. This imbalance suggests the lab’s commercial arrangements and state contracts, as reflected in high-volume Medicaid codes, are the primary revenue drivers for the organization.
Revenue concentration is notable on both payers: the top three Medicare codes account for 35.0% of Medicare revenue and the top three Medicaid codes account for 50.9% of Medicaid revenue. For Medicare the highest-revenue codes include 36415 ($4.9M, 12.8%), 80053 ($4.9M, 12.7%), and 84443 ($3.6M, 9.5%); for Medicaid the top contributors are U0003 ($80.3M, 36.6%), G0480 ($16.4M, 7.5%), and 80050 ($14.9M, 6.8%).
The code mix indicates a high-throughput clinical diagnostics and specimen-collection operation: frequent billing for phlebotomy and routine panels (36415; 85025; 80053; 80061) together with very large volumes of infectious disease molecular testing (U0003) and definitive drug testing (G0480). This combination—large counts of basic chemistry/hematology panels plus massive molecular and toxicology volumes—maps to a centralized reference-laboratory model that processes both routine outpatient screening and specialized high-cost molecular assays.
Competitive standing in Medicare is that of a national-volume leader for many routine tests: multiple Medicare codes (for example 36415, 80053, 84443, 85025, 80061) are labeled "extreme outlier" and sit at the 100th percentile or near it, with ranks such as 36415 at #6 of 86467 and 80053 at #9 of 26416. Those ranks indicate the provider operates far above typical national volume for common lab services and is a major national participant for those panels and collection services.
In Medicaid the provider demonstrates statewide dominance on several high-revenue services: U0003 is $80.3M (36.6%) and ranks #2 of 108 in-state (99th percentile; extreme outlier), G0480 is $16.4M (7.5%) and ranks #1 of 61 (100th percentile; extreme outlier), and 80050 is $14.9M (6.8%) and ranks #1 of 32 (100th percentile; extreme outlier). These positions denote a leading role in Arizona for COVID PCR, definitive toxicology, and broad screening panels, making the lab a primary conduit for high-volume Medicaid testing in the state.
Payment and volume profile suggests a low-margin, high-volume throughput for many routine tests and a mixed-margin profile overall: examples include Medicaid 80061 at 1.5M claims with $6 avg paid/claim and 80050 at 1.1M claims with $13 avg paid/claim, while higher-price molecular items like U0003 pay $91 avg/claim (882.1K claims). The coexistence of millions of low-unit-value claims and large-dollar molecular testing implies scale-driven economics where revenue depends on volume for low-cost panels and on a few high-dollar assays for outsized Medicaid revenue.
Tenure is long-standing: the NPI was enumerated on 2006-06-21 (~20 years ago), indicating the provider has operated and billed Medicare/Medicaid for roughly two decades. That longevity supports the interpretation of sustained, large-scale operations rather than a short-term billing spike.
Not all lines are exceptional: a handful of specialized codes show more typical volumes or percentiles (for example Medicare 81479 at 560 claims, $660.8K revenue, 68th percentile; Medicaid 80081 ranks #1 of 4 and is labeled "typical, unremarkable"), so while many routine and public-health–scale tests are extreme outliers, some specialized pathology and obstetric panels remain within expected state or national ranges. This mix indicates a primary focus on high-volume clinical and public-health testing alongside a smaller, more typical portfolio of specialized 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.
570 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 610,150 | $10 | $4.9M |
| 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. | 485,680 | $10 | $4.9M |
| 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… | 227,240 | $20 | $3.6M |
| 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… | 444,480 | $10 | $3.6M |
| 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. | 267,170 | $10 | $3.5M |
| 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… | 96,920 | $30 | $2.8M |
| 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).… | 190,430 | $10 | $1.9M |
| 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. | 44,070 | $40 | $1.8M |
| 82607 | The lab analyst performs a test to measure the amount of vitamin B12 in a patient specimen, typically in patient blood. | 79,340 | $20 | $1.2M |
| 84153 | The lab analyst performs testing for total prostate specific antigen, PSA, typically on serum or plasma samples using laboratory analyzers. PSA is a protein the prostate gland produces, and… | 63,000 | $20 | $1.1M |
Showing 1–10 of 570
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 570 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
570 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 81479 | 3 | 10 | 560 | $3,210 | $17.3M |
| 87798 | 6 | 10 | 650 | $30 | $553.2K |
| 86320 | 1 | 10 | 11,570 | $30 | $338.1K |
| 86003 | 2 | 10 | 48,520 | $10 | $302K |
| 86481 | 1 | 10 | 2,780 | $100 | $270.1K |
| 83876 | 1 | 10 | 4,170 | $50 | $207.5K |
| 82784 | 1 | 10 | 11,640 | $10 | $197.3K |
| 83521 | 1 | 10 | 8,690 | $20 | $174.5K |
| U0003 | 2 | 10 | 230 | $70 | $166.6K |
| 81450 | 2 | 10 | 220 | $740 | $160.8K |
Showing 1–10 of 570
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.
548 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… | 882,130 | $90 | $80.3M |
| 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… | 349,660 | $50 | $16.4M |
| 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… | 1,143,880 | $10 | $14.9M |
| 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. | 473,990 | $30 | $14.2M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 593,550 | $20 | $9.5M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 592,790 | $20 | $9.5M |
| 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. | 1,498,390 | $10 | $9M |
| 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… | 757,580 | $10 | $8.3M |
| 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. | 1,669,030 | $1 | $6.7M |
| 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).… | 1,234,750 | $10 | $6.2M |
Showing 1–10 of 548
How this provider's Medicaid billing volume and revenue compare to other Arizona providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Arizona median
548 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 2 | 110 | 960 | $70 | $1.7M |
| 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 | 10 | 22,030 | $60 | $1.3M |
| 86003 | The lab analyst performs the technical lab test to analyze a specimen such as serum for allergen–specific immunoglobulin E (IgE), using a crude allergen extract. The test result is quantitative or… | 2 | 10 | 1,620 | $40 | $1.3M |
| 81479 | Use 81479 to report a molecular pathology procedure that does not have a specific code. | 4 | 10 | 1,340 | $200 | $1.2M |
| 80081 | The lab analyst performs an obstetric panel; this panel must include tests for a complete blood count with differential, a hepatitis B surface antigen test, a single–result test for HIV–1 antigens… | 1 | 10 | 17,850 | $30 | $995.7K |
| 81229 | The lab analyst performs the technical lab test using comparative genomic hybridization (CGH) microarray, also referred to as chromosomal microarray (CMA) or molecular karyotype performed by… | 2 | 10 | 1,350 | $670 | $982K |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 2 | 20 | 250 | $40 | $915.9K |
| 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… | 1 | 30 | 470 | $20 | $761.9K |
| 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… | 5 | 40 | 190 | $30 | $662.3K |
| 87902 | The lab analyst performs the technical lab test to analyze the specific genotype by nucleic acid of a specimen containing hepatitis C virus. | 1 | 10 | 3,410 | $100 | $493.4K |
Showing 1–10 of 548
Other providers in the same ZIP code as Sonora Quest Laboratories LLC, ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.