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

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

Lowcountry Pediatrics (NPI 1164531349)

Lowcountry Pediatrics is a specialist provider located in Goose Creek, South Carolina. This profile covers 0 Medicare and 58 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	Lowcountry Pediatrics
Address	101 Springhall Dr
City	Goose Creek
State	SC
ZIP	29445
Taxonomy	Specialist
NPI Enumerated	August 30, 2006

Payer Source	Total Paid
Medicaid	$2.2M
Medicare	$0

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

58 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…	10,320	$60	$640.1K
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…	6,700	$90	$629.3K
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…	1,990	$90	$178.9K
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…	1,790	$90	$156K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,090	$80	$90.7K
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.	3,970	$20	$79.4K
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…	560	$130	$71.4K
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…	2,220	$20	$53.3K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	2,110	$30	$52.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	480	$90	$42.9K

Showing 1–10 of 58

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Carolina Distribution

Lowcountry Pediatrics — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. South Carolina median

58 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	94	280	600	$90	$299K
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…	231	2,770	210	$60	$254.5K
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…	235	2,480	350	$80	$246K
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…	92	380	160	$100	$226.8K
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…	281	410	330	$50	$152.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	99	390	100	$100	$148.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	107	340	110	$110	$107.9K
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,…	417	610	190	$50	$98.4K
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.	111	650	140	$30	$98.1K
G9153	Mapcp demonstration - physician incentive pool	117	140	420	$50	$91.9K

Showing 1–10 of 58

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Acsr, Inc.	SC	Adult Day Care Clinic/Center	$0	$3.9M
Brent R. Humphrey Dmd, P.A.	SC	Pediatric Dentistry	$0	$1.8M
Charleston Carenow Urgent Care, LLC	SC	Urgent Care Clinic/Center	$0	$1.8M
Donald Hanna	SC	Family Medicine Physician	$675.4K	$0
John Sutterlin	SC	Family Medicine Physician	$307.7K	$16.7K
Corynne Boyer	SC	Internal Medicine Physician	$90.8K	$0
Hubert Murray	SC	Chiropractor	$90.5K	$0
Lloyd Mandel	SC	Surgery Physician	$78.3K	$0
Carey Mcnamara	SC	Medical Physician Assistant	$40.8K	$0
Karen King	SC	Optometrist	$2.4K	$13.8K

Lowcountry Pediatrics — Billing Profile & Reimbursement Data

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Lowcountry Pediatrics — 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