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NPI 1841236684 · Pittsburgh, PA · Clinical Medical Laboratory
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Quest Diagnostics Of Pennsylvania, Inc. is a clinical medical laboratory provider located in Pittsburgh, Pennsylvania. This profile covers 465 Medicare and 494 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 | Quest Diagnostics Of Pennsylvania, Inc. |
| Address | 875 Greentree Rd |
| City | Pittsburgh |
| State | PA |
| ZIP | 15220 |
| 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 | $132.4M |
| Medicare | $11.3M |
QUEST DIAGNOSTICS OF PENNSYLVANIA, INC. is a high-throughput clinical medical laboratory: its top Medicare procedure codes are dominated by specimen collection and routine chemistry panels (examples include 36415, 80053, 80061) and its Medicaid mix is heavily weighted to both high-volume molecular infectious testing and drug screening (notably 80307 and U0003). The presence of large claim counts for 36415 (125.4K claims), 80053 (90.7K claims) and 80061 (63.1K claims) on Medicare alongside 761.6K claims for 80307 and 252.2K claims for U0003 on Medicaid supports an operational model focused on mass specimen collection, automated chemistry, infectious disease NAATs, and toxicology workflows. These code-level patterns are consistent with a centralized/high-throughput reference lab rather than a small onsite clinical lab.
Revenue concentration differs by payer: the provider's top three Medicare codes account for 35.2% of its total Medicare revenue, while the top three Medicaid codes account for 47.9% of its total Medicaid revenue. This concentration indicates that a relatively small set of tests (routine venipuncture and core panels on Medicare; drug testing and high-volume NAATs on Medicaid) drive a large share of billing for each payer, making payer-specific test mixes key to revenue risk and contracting discussions.
The payer mix is heavily Medicaid-weighted in scale: lifetime Medicare revenue is $11.3M while lifetime Medicaid revenue is $132.4M. This asymmetry means the provider’s financial exposure and leverage will be driven primarily by Medicaid contract terms, reimbursement changes, and state-level policy for high-volume codes such as 80307 ($20.6M revenue) and U0003 ($18.4M revenue).
Competitive standing on Medicare shows unusually large national throughput for many routine lab codes: 36415 generates $1M revenue and ranks #34 of 86467 providers nationally (100th percentile; extreme outlier), 80053 generates $907.2K and ranks #43 of 26416 (100th percentile; extreme outlier), and 80061 generates $820.1K and ranks #40 of 21671 (100th percentile; extreme outlier). These national percentile positions indicate that, despite relatively modest total Medicare revenue ($11.3M), this provider processes routine Medicare lab tests at volumes far above typical peers on a per-code basis.
In-state competitive standing on Medicaid is dominant for core volumes: the provider ranks #1 in Pennsylvania for many high-revenue Medicaid codes, including 80307 (761.6K claims, $20.6M revenue), U0003 (252.2K claims, $18.4M revenue), 87491 (319.6K claims, $6.7M revenue) and 87591 (316.1K claims, $6.3M revenue). The repeated #1 ranks and 100th percentile designations show it is a leading statewide processing center for both STI NAATs and toxicology panels, a factor payers should treat as evidence of market dominance for those service lines.
Drug testing and toxicology represent a material service line across payers: G0480 appears on both Medicare (4.3K claims, $482.8K revenue; ranks #30 of 1590 providers nationally, 98th percentile; notably above typical) and Medicaid (164.4K claims, $5.6M revenue; ranks #4 of 132 in-state, 98th percentile; notably above typical). Coupled with large-volume presumptive screens (80307: 761.6K claims on Medicaid), this profile signals integrated presumptive-to-definitive toxicology workflows that likely support addiction treatment, employment screening, and clinical toxicology programs at scale.
Statistical outlier signals should guide review of utilization mix rather than imply any specific compliance issue: many Medicare codes are labeled as "extreme outlier" (examples include 36415, 80053, 80061, 84443) reflecting nationally exceptional volume for these procedures, while numerous Medicaid codes are similarly labeled in-state (e.g., 80307, U0003, 87491, 87591). A smaller set of codes on Medicare and Medicaid are described as "typical, unremarkable" or "notably above typical" (for example, 83970 on Medicare is "typical, unremarkable"), indicating heterogeneity in how this provider’s unusually high throughput is distributed across tests.
Tenure and operational maturity are evident: the NPI was enumerated on 2006-06-21 (~20 years ago), consistent with an established laboratory operation. Combined with the scale and rank data across both payers, this suggests a long-standing regional lab presence that has grown into a major Medicaid processing hub while maintaining nationally notable Medicare throughput for routine laboratory 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.
465 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. | 125,360 | $10 | $1M |
| 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. | 90,720 | $10 | $907.2K |
| 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. | 63,090 | $10 | $820.1K |
| 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… | 47,210 | $20 | $755.3K |
| 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… | 20,150 | $30 | $584.4K |
| 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… | 70,970 | $10 | $567.8K |
| 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… | 4,310 | $110 | $482.8K |
| 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).… | 33,740 | $10 | $337.4K |
| 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. | 4,600 | $60 | $280.8K |
| 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. | 5,860 | $40 | $234.3K |
Showing 1–10 of 465
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 465 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
465 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 81479 | 3 | 10 | 30 | $2,950 | $2.2M |
| 87798 | 34 | 40 | 1,250 | $30 | $1.1M |
| 87799 | 5 | 10 | 790 | $40 | $128.8K |
| 87563 | 7 | 10 | 1,340 | $30 | $116K |
| 87625 | 4 | 10 | 70 | $40 | $107.4K |
| 81279 | 3 | 10 | 110 | $180 | $98.5K |
| 81339 | 3 | 10 | 60 | $180 | $97K |
| 87529 | 10 | 10 | 80 | $30 | $96.6K |
| G0480 | 2 | 40 | 270 | $110 | $94.5K |
| 81513 | 2 | 10 | 490 | $140 | $86.1K |
Showing 1–10 of 465
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
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Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
494 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 761,590 | $30 | $20.6M |
| 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… | 252,170 | $70 | $18.4M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 319,570 | $20 | $6.7M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 316,070 | $20 | $6.3M |
| 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… | 164,420 | $30 | $5.6M |
| 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. | 591,020 | $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… | 205,060 | $20 | $3.1M |
| 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. | 437,310 | $10 | $3.1M |
| 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… | 376,280 | $10 | $3M |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 171,370 | $10 | $2.4M |
Showing 1–10 of 494
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
494 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| G0481 | 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… | 9 | 20 | 710 | $80 | $1.7M |
| 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… | 4 | 130 | 310 | $60 | $769.3K |
| 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. | 1 | 210 | 730 | $40 | $689.7K |
| 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,… | 1 | 10 | 1,270 | $340 | $567.5K |
| 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 | 200 | 990 | $70 | $517.5K |
| G0483 | 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… | 12 | 20 | 3,040 | $60 | $483.4K |
| 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… | 6 | 20 | 540 | $50 | $367.6K |
| 81220 | The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR… | 1 | 10 | 470 | $260 | $227K |
| 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 | 70 | $150 | $154.4K |
| 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… | 8 | 60 | 110 | $220 | $151.2K |
Showing 1–10 of 494
Other providers in the same ZIP code as Quest Diagnostics Of Pennsylvania, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Quest Diagnostics Venture LLC | PA | Clinical Medical Laboratory | $7.2M | $96M |
| Institute For Dermatopathology, Inc. | PA | Clinical Medical Laboratory | $1.5M | $522.1K |
| Danielle Sharek | PA | Diagnostic Radiology Physician | $170.5K | $2.1K |
| Gautam Patel | PA | Diagnostic Radiology Physician | $70.1K | $6K |
| Philip Galapon | PA | Family Medicine Physician | $72.4K | $0 |
| Magali Fontaine | PA | Clinical Pathology Physician | $14.9K | $0 |
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