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 Michigan for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Michigan 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. Michigan (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.

Pediatric Consultants Of Troy, P.C. (NPI 1003821661)

Pediatric Consultants Of Troy, P.C. is a pediatrics physician provider located in Rochester Hills, Michigan. This profile covers 0 Medicare and 61 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Pediatric Consultants Of Troy, P.C.
Address	633 South Blvd E Ste 2400
City	Rochester Hills
State	MI
ZIP	48307
Taxonomy	Pediatrics Physician
NPI Enumerated	July 30, 2006

Payer Source	Total Paid
Medicaid	$6.1M
Medicare	$0

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

61 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	36,140	$60	$2.3M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	10,330	$90	$940.2K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	8,800	$80	$721.7K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	7,930	$70	$563.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6,150	$80	$510.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,590	$90	$230.5K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	7,580	$20	$113.6K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	12,390	$10	$111.5K
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…	15,000	$10	$105K
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	1,300	$80	$103.6K

Showing 1–10 of 61

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

Pediatric Consultants Of Troy, P.C. — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

61 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	377	4,380	1,000	$70	$289.9K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	118	4,770	1,060	$50	$247.8K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	81	130	1,180	$80	$231.2K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	36	670	730	$60	$140K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	43	590	850	$50	$134.5K
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.	221	270	1,950	$10	$131.1K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	960	1,170	170	$90	$107.9K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	1,766	1,860	220	$90	$96.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	42	720	420	$60	$93.9K
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	474	2,000	260	$60	$84.2K

Showing 1–10 of 61

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Henry Ford Health Rochester Hospital	MI	General Acute Care Hospital	$0	$12M
Osi, LLC	MI	Ambulatory Surgical Clinic/Center	$1.8M	$0
Rochester Endoscopy & Surgery Center, L.L.C.	MI	Ambulatory Surgical Clinic/Center	$1.2M	$1.4K
Ayad Abrou	MI	MOHS-Micrographic Surgery Physician	$1.1M	$0
David Byrd	MI	MOHS-Micrographic Surgery Physician	$829.3K	$0
Delfin Santos	MI	Rheumatology Physician	$743K	$0
Zakwan Mahjoub	MI	Interventional Cardiology Physician	$687K	$0
Mukesh Shah	MI	Hematology & Oncology Physician	$619.3K	$0
Farah Dawood-farah	MI	Endocrinology, Diabetes & Metabolism Physician	$533.3K	$0
Julie Byrd	MI	Dermatology Physician	$485.5K	$0

Pediatric Consultants Of Troy, P.C. — Billing Profile & Reimbursement Data

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Pediatric Consultants Of Troy, P.C. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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