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

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

Southwest Children's Clinic (NPI 1144345737)

Southwest Children's Clinic is a specialist provider located in West Jordan, Utah. This profile covers 0 Medicare and 57 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	Southwest Children's Clinic
Address	8822 So Redwood Rd
City	West Jordan
State	UT
ZIP	84088
Taxonomy	Specialist
NPI Enumerated	March 20, 2007

Payer Source	Total Paid
Medicaid	$700.5K
Medicare	$0

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

57 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…	5,390	$60	$344.9K
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…	2,020	$90	$173.5K
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…	1,040	$40	$41.6K
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…	990	$40	$35.5K
0241U	N/A	220	$100	$21.5K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	350	$30	$11.2K
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…	80	$110	$9.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	520	$20	$8.9K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	220	$40	$8.5K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	3,950	$1	$7.9K

Showing 1–10 of 57

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

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

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

57 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
0241U	N/A	60	70	770	$130	$162.4K
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…	198	1,340	200	$80	$144K
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…	82	1,360	190	$70	$125K
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…	129	200	240	$90	$85.8K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	155	160	250	$50	$76.9K
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…	42	220	200	$80	$74K
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…	34	190	150	$80	$58.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	29	150	60	$70	$32.2K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	15	50	110	$30	$31.7K
97802	The provider treats medical conditions and related symptoms using specific diet therapy by interacting individually with the patient. This code represents each 15 minutes of the first visit with the…	10	10	50	$110	$28.3K

Showing 1–10 of 57

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Utah Homecare LLC	UT	Home Health Agency	$0	$14.9M
Jordan Valley Medical Center LP	UT	Rehabilitation Hospital Unit	$0	$9.1M
Affinity Behavior And Mental Health Services, LLC	UT	Community/Behavioral Health Agency	$0	$7.4M
Jordan Valley Medical Center LP	UT	General Acute Care Hospital	$0	$7.3M
Wasatch Pediatrics, Inc	UT	Pediatrics Physician	$0	$5.8M
Family Surgical Suite	UT	Ambulatory Surgical Clinic/Center	$0	$4.8M
Kids Behavioral Health Of Utah, Inc	UT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$4.1M
Douglas Mehr	UT	Retina Specialist (Ophthalmology) Physician	$2.7M	$0
Christopher Gee	UT	Retina Specialist (Ophthalmology) Physician	$1.9M	$0
Andrew Davis	UT	Retina Specialist (Ophthalmology) Physician	$1.8M	$0

Southwest Children's Clinic — Billing Profile & Reimbursement Data

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Southwest 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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References