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NPI 1932145778 · Clifton, NJ · Clinical Medical Laboratory
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Quest Diagnostics Incorporated is a clinical medical laboratory provider located in Clifton, New Jersey. This profile covers 646 Medicare and 684 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 Incorporated |
| Address | 1 Insights Dr |
| City | Clifton |
| State | NJ |
| ZIP | 07012 |
| 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 | $637.7M |
| Medicare | $111.2M |
Payer mix and scale: QUEST DIAGNOSTICS INCORPORATED reports $111.2M in total Medicare revenue and $637.7M in total Medicaid revenue, indicating Medicaid is the dominant payer by scale for this entity. The provider is effectively a major Medicaid revenue generator in-state while maintaining a meaningful Medicare footprint.
Revenue concentration by code: The provider’s Medicare revenue is concentrated, with the precomputed top 3 Medicare codes accounting for 35.7% of total Medicare revenue, and its Medicaid revenue shows similar concentration with the top 3 Medicaid codes accounting for 37.6% of total Medicaid revenue. This concentration implies that a relatively small set of tests drives a large share of payer-specific revenue.
Clinical laboratory service mix: The billed code mix—heavy representation of routine chemistry and endocrinology panels such as 80053, 80061, 84443, 85025, 82306 and 83036—is consistent with a high-volume clinical medical laboratory focused on outpatient diagnostic testing, chronic disease monitoring, and preventive screening. The presence of both common panels (e.g., 80053, 80061) and condition-specific assays (e.g., 82306 vitamin D, 83036 A1C, 84443 TSH) indicates a broad menu supporting primary care and chronic disease management.
National competitive standing on Medicare: For multiple high-revenue Medicare codes the provider ranks at the very top nationally—80053 ranks #3 of 26416 providers nationally (100th percentile; extreme outlier), 80061 ranks #4 of 21671 (100th percentile; extreme outlier), and 84443 ranks #3 of 19722 (100th percentile; extreme outlier). Those rank and percentile labels identify the provider as an outlier with far above-typical national volume for core chemistry and endocrine tests, signaling national-scale throughput for these services.
State-level dominance on Medicaid testing mix: In Medicaid the provider reports extremely large volumes and revenues for pandemic and public-health–oriented tests—U0003 shows 1.3M claims and $95.1M revenue and ranks #3 in-state (98th percentile; extreme outlier), while STI and drug-screening codes such as 87491 ($31.5M, ranks #3 in-state, 98th percentile) and 80307 ($32.5M, ranks #2 in-state, 99th percentile) also appear as top Medicaid drivers. These in-state rankings and the large-dollar COVID and STI testing lines indicate the provider is a major statewide laboratory partner for high-volume infectious disease and screening workflows.
High-acuity and specialty testing revenue lines: Beyond routine panels, the provider bills for higher-cost molecular and genomic services on Medicaid (for example, 81420 with $6.7M revenue and 81220 with $6.5M revenue) and definitive toxicology on Medicare (G0480 with $1.7M revenue) and Medicaid (G0480 $10.7M revenue in-state). The presence of both high-volume low-cost panels and lower-volume higher-paid molecular/genomic assays signals a mixed service model that combines scale chemistry/hematology work with specialized, higher-margin diagnostics.
Operational implications from claim volumes: Reported claim volumes are very large for core tests—examples include 892.7K claims for 80053 and 633.4K claims for 80061 on Medicare, and 1.3M claims for U0003 and 1.2M claims for 80307 on Medicaid—consistent with centralized, high-throughput laboratory operations and automated processing required to handle mass specimen throughput. Such claim counts imply economies of scale and systems designed for batch processing, specimen routing, and automated result generation.
Tenure and market presence: The NPI was enumerated on 2006-06-21 (~20 years ago), indicating long-standing enrollment and operational tenure in Medicare/Medicaid, which supports its position as an established provider with sustained high-volume billing patterns across both payers.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
646 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 892,700 | $10 | $8.9M |
| 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. | 633,370 | $10 | $8.2M |
| 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… | 510,030 | $20 | $8.2M |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 794,470 | $10 | $6.4M |
| 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… | 713,190 | $10 | $5.7M |
| 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… | 192,390 | $30 | $5.6M |
| 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).… | 473,870 | $10 | $4.7M |
| 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. | 60,850 | $40 | $2.4M |
| 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… | 124,530 | $20 | $2.2M |
| 84439 | The lab analyst performs a test to measure free thyroxine, or free T4, typically in patient serum. | 205,420 | $10 | $1.8M |
Showing 1–10 of 646
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 646 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
646 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 81450 | 4 | 10 | 230 | $740 | $833.5K |
| 87506 | 4 | 10 | 110 | $260 | $506.1K |
| G0145 | 2 | 10 | 11,530 | $30 | $288.2K |
| 87798 | 14 | 40 | 1,760 | $30 | $284.3K |
| G0472 | 2 | 10 | 5,530 | $50 | $253.9K |
| 81513 | 1 | 10 | 60 | $140 | $217.2K |
| 87536 | 2 | 10 | 2,150 | $80 | $207K |
| 87799 | 2 | 10 | 4,810 | $40 | $202.8K |
| 81339 | 5 | 10 | 930 | $180 | $195.7K |
| 87497 | 1 | 10 | 5,320 | $40 | $177.7K |
Showing 1–10 of 646
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.
684 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… | 1,267,340 | $80 | $95.1M |
| 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. | 1,202,540 | $30 | $32.5M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 1,657,300 | $20 | $31.5M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 1,635,830 | $20 | $31.1M |
| 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… | 1,372,820 | $20 | $22M |
| 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. | 2,911,840 | $10 | $17.5M |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 507,070 | $30 | $17.2M |
| 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… | 957,690 | $20 | $17.2M |
| 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. | 2,795,610 | $10 | $16.8M |
| 86769 | The lab analyst performs a multiple–step immunoassay to evaluate the patient’s serum for antibodies to severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), which causes coronavirus disease… | 402,700 | $40 | $14.9M |
Showing 1–10 of 684
How this provider's Medicaid billing volume and revenue compare to other New Jersey providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New Jersey median
684 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… | 3 | 130 | 3,180 | $60 | $4.2M |
| 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 | 5,420 | $280 | $4.1M |
| 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… | 15 | 30 | 2,020 | $110 | $2M |
| 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… | 2 | 40 | 590 | $20 | $1.9M |
| 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. | 2 | 150 | 3,680 | $30 | $1.5M |
| 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… | 8 | 40 | 1,690 | $70 | $1.4M |
| 86480 | The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies. | 2 | 40 | 810 | $30 | $1.4M |
| 88175 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 3 | 20 | 750 | $10 | $1.3M |
| 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… | 3 | 30 | 210 | $200 | $1.3M |
| 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 | 51,370 | $40 | $1.3M |
Showing 1–10 of 684
Other providers in the same ZIP code as Quest Diagnostics Incorporated, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Serv Centers Of New Jersey, Inc | NJ | Mental Health Clinic/Center (Including Community Mental Health Center) | $0 | $8.6M |
| Ameripath New York, LLC | NJ | Clinical Medical Laboratory | $684.8K | $1.6M |
| Ayelet Nelson | NJ | Adult Health Nurse Practitioner | $536.5K | $0 |
| Daniel Lowe | NJ | Urology Physician | $366.7K | $0 |
| Luisa Lerma | NJ | Anatomic Pathology & Clinical Pathology Physician | $365.3K | $0 |
| Atul Prakash | NJ | Clinical Cardiac Electrophysiology Physician | $340.6K | $0 |
| Sanjiv Parikh | NJ | Specialist | $329.6K | $0 |
| Linda Singletary | NJ | Diagnostic Radiology Physician | $315.6K | $0 |
| Brian Schactman | NJ | Internal Medicine Physician | $267.1K | $0 |
| Ephraim Yablok | NJ | Physical Therapist | $237.7K | $0 |
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