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

Why is the Medicaid comparison limited to Puerto Rico 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. Puerto Rico (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.

Advanced Prenatal Diagnosis LLC (NPI 1144788548)

Field	Value
Entity Type	Organization
Organization	Advanced Prenatal Diagnosis LLC
Address	1451 Avenida Ashford
City	San Juan
State	PR
ZIP	00902
Taxonomy	Maternal & Fetal Medicine Physician
NPI Enumerated	March 5, 2019

Payer Source	Total Paid
Medicaid	$1.1M
Medicare	$0

Medicaid: Complete Services Breakdown

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	2,110	$100	$219.9K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	2,870	$60	$174.9K
99242	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a straightforward level of medical decision making or the…	2,580	$70	$167.4K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	4,110	$30	$131.5K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	2,270	$50	$118.2K
99443	N/A	1,330	$90	$116.6K
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	1,720	$60	$96.4K
76801	In this procedure, the provider performs a real time or live image, ultrasound of a pregnant uterus for examination of the first or a single fetus and mother during the first trimester, or less than…	630	$80	$50.2K
76813	The provider uses either a transabdominal or transvaginal ultrasound to measure the fetal nuchal translucency, or the clear, fluid–filled space at the back of the neck, of the first or a single…	450	$80	$36.9K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	30	$30	$780

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Puerto Rico Distribution

Advanced Prenatal Diagnosis LLC — 4 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Puerto Rico

Full comparison — all codes billed, vs. Puerto Rico median

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	6	20	910	$110	$303K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	3	10	910	$70	$93.9K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	4	20	80	$70	$75.4K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	8	10	50	$40	$52.5K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	3	70	240	$30	$24.4K
76813	The provider uses either a transabdominal or transvaginal ultrasound to measure the fetal nuchal translucency, or the clear, fluid–filled space at the back of the neck, of the first or a single…	1	10	240	$80	$20.6K
99242	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a straightforward level of medical decision making or the…	4	90	170	$30	$18K
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	3	60	90	$50	$16.4K
76801	In this procedure, the provider performs a real time or live image, ultrasound of a pregnant uterus for examination of the first or a single fetus and mother during the first trimester, or less than…	3	20	40	$70	$16K
99443	N/A	24	210	110	$10	$9.8K

Advanced Prenatal Diagnosis LLC — Billing Profile & Reimbursement Data

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Advanced Prenatal Diagnosis 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

Frequently Asked Questions

References