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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Abc Pediatrics, PLLC (NPI 1154429041)

Abc Pediatrics, PLLC is a pediatrics physician provider located in Charleston, West Virginia. This profile covers 0 Medicare and 46 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	Abc Pediatrics, PLLC
Address	830 Pennsylvania Ave
City	Charleston
State	WV
ZIP	25302
Taxonomy	Pediatrics Physician
NPI Enumerated	September 21, 2006

Payer Source	Total Paid
Medicaid	$2.9M
Medicare	$0

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

46 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…	21,440	$50	$1.2M
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…	4,930	$70	$345.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4,030	$70	$286.1K
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…	4,640	$60	$283.1K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	11,990	$10	$167.9K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	10,460	$10	$125.5K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	6,240	$20	$124.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,420	$80	$109.6K
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,…	1,840	$30	$62.7K
87430	The lab analyst performs an assay to evaluate the patient’s sample for antigens to Streptococcus, group A, using an immunoassay method, such as EIA.	1,750	$20	$28K

Showing 1–10 of 46

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Abc Pediatrics, PLLC — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

46 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	109	1,270	1,240	$30	$245K
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…	810	1,030	890	$50	$221K
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…	12	150	520	$50	$76.2K
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…	13	140	550	$50	$67.2K
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…	357	440	110	$60	$57.2K
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,…	111	540	320	$20	$43.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	11	190	220	$50	$42.7K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	124	190	190	$30	$35.9K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	5	120	440	$10	$28.2K
87400	The lab analyst performs the technical lab test to detect antigens of influenza A or B using an immunoassay technique, such as EIA. This analysis will distinguish if a patient has influenza A or B.	15	20	420	$10	$27.4K

Showing 1–10 of 46

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Healthnet Aeromedical Services Inc.	WV	Air Ambulance	$4.1M	$24.1M
Home Base Inc.	WV	Community/Behavioral Health Agency	$0	$14.5M
Appalachian Labs Of Wv LLC	WV	Clinical Medical Laboratory	$359.3K	$11M
Womencare Inc	WV	Federally Qualified Health Center (FQHC)	$0	$7.4M
Allied Nursing And Community Service	WV	Case Management Agency	$0	$5.4M
Devaraj Behavioral Healthcare PLLC	WV	Community/Behavioral Health Agency	$0	$4.8M
Pediatrix Medical Group PC	WV	Neonatal-Perinatal Medicine Physician	$0	$3.7M
South Charleston Pediatrics	WV	Pediatrics Physician	$0	$3.6M
Kanawha Valley Senior Services	WV	Home Health Agency	$0	$2.2M
Randall J. Hill, M.d., P.L.L.C.	WV	Specialist	$0	$1.9M

Abc Pediatrics, PLLC — Billing Profile & Reimbursement Data

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Abc Pediatrics, PLLC — 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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