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

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

Hirata Pediatrics LLC (NPI 1124240817)

Hirata Pediatrics LLC is a pediatrics physician provider located in Las Vegas, Nevada. 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	Hirata Pediatrics LLC
Address	3196 S Maryland Pkwy Ste 208
City	Las Vegas
State	NV
ZIP	89109
Taxonomy	Pediatrics Physician
NPI Enumerated	May 3, 2007

Payer Source	Total Paid
Medicaid	$2.5M
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…	7,750	$60	$488.4K
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…	5,190	$90	$467K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	9,260	$40	$398K
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…	3,460	$100	$332.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,530	$90	$140.9K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	3,640	$40	$134.8K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	980	$80	$82.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	700	$100	$70.4K
99070	Then provider utilizes items or supplies materials to the patient in excess of what is normally utilized or provided during an encounter. These items might include medical supplies, medications,…	6,050	$10	$66.5K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	960	$60	$60.4K

Showing 1–10 of 61

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nevada Distribution

Hirata Pediatrics LLC — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nevada

Full comparison — all codes billed, vs. Nevada 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…	975	2,250	290	$60	$138K
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…	163	2,480	330	$50	$107.6K
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…	21	300	280	$80	$103.8K
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…	28	300	240	$80	$97.1K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	25	310	410	$40	$95K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	194	450	470	$40	$92K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	43	270	170	$80	$70.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	43	220	130	$80	$57K
Q3014	Telehealth originating site facility fee	128	390	670	$20	$42.6K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	16	160	60	$50	$28.4K

Showing 1–10 of 61

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sunrise Hospital And Medical Center, LLC	NV	General Acute Care Hospital	$0	$85.9M
Fremont Emergency Services Scherr Ltd	NV	Emergency Medicine Physician	$0	$20.9M
Sunrise Hospital And Medical Center, LLC	NV	General Acute Care Hospital	$0	$17.1M
Sanjay Kandoth Md PC	NV	Pediatrics Physician	$0	$14.6M
Sdmi, LLC	NV	Diagnostic Radiology Physician	$0	$14.3M
Harold Zilberman M D Chtd	NV	Pediatrics Physician	$0	$14.3M
Radiology Specialists Ltd Marasso-miller	NV	Diagnostic Radiology Physician	$0	$13.9M
1st Love & Life Caregivers, LLC	NV	In Home Supportive Care Agency	$0	$10.8M
Childrens Lung Specialists	NV	Pediatric Pulmonology Physician	$0	$8.6M
Jlk Home Care, Inc	NV	In Home Supportive Care Agency	$0	$5.1M

Hirata Pediatrics LLC — Billing Profile & Reimbursement Data

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Hirata Pediatrics LLC — 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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