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

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

Valley Children's Clinic (NPI 1063628576)

Valley Children's Clinic is a pediatric adolescent medicine physician provider located in Renton, Washington. This profile covers 0 Medicare and 59 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	Valley Children's Clinic
Address	4011 Talbot Rd S Ste 220
City	Renton
State	WA
ZIP	98055
Taxonomy	Pediatric Adolescent Medicine Physician
NPI Enumerated	May 15, 2007

Payer Source	Total Paid
Medicaid	$5.2M
Medicare	$0

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

59 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…	29,240	$70	$2M
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…	7,450	$100	$707.5K
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…	7,970	$90	$701.5K
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…	6,500	$100	$656.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,540	$100	$339.5K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	6,500	$20	$104K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	1,910	$50	$95.4K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	5,040	$10	$70.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	560	$100	$58K
99177	The provider uses instruments to conduct a vision screening exam to analyze both eyes to diagnose ocular or eye–related diseases. Both the screening and analysis take place on–site.	6,310	$10	$56.8K

Showing 1–10 of 59

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Washington Distribution

Valley Children's Clinic — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

59 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…	266	1,820	480	$60	$379.6K
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…	95	1,860	610	$40	$295.5K
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…	27	280	540	$70	$166.5K
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…	26	300	400	$80	$164.4K
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…	299	540	130	$90	$128.6K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	66	210	690	$40	$114.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	39	320	290	$70	$104.8K
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.	142	180	950	$10	$104.6K
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…	160	270	2,880	$1	$100.6K
92587	Code 92587 is in the Medicine/Special Otorhinolaryngologic Services Section. It involves special procedures of the ears/nose/throat. This code is for screening purposes with interpretation and…	6	30	450	$70	$66.9K

Showing 1–10 of 59

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Public Hospital District 1 Of King County	WA	General Acute Care Hospital	$0	$120.6M
Valley Medical Group-renton	WA	General Acute Care Hospital	$0	$28.3M
Associated Emergency Room Physicians, Inc P.s.	WA	Emergency Medicine Physician	$0	$12M
Retina Institute, PLLC	WA	Retina Specialist (Ophthalmology) Physician	$0	$5.5M
Proliance Surgery Center At Valley, LLC	WA	Ambulatory Surgical Clinic/Center	$3.3M	$0
Vantage Radiology & Diagnostic Services, A Professional Services Corp	WA	Diagnostic Radiology Physician	$0	$2.6M
George Ko	WA	Retina Specialist (Ophthalmology) Physician	$1.7M	$0
Kenneth Fung	WA	Ophthalmology Physician	$1.6M	$0
Renton Regional Fire Authority	WA	Land Ambulance	$229.9K	$186.7K
Craig Fujisaki	WA	Dermatology Physician	$376.9K	$0

Valley Children's Clinic — 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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