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.

The Children's Clinic (NPI 1184841942)

The Children's Clinic is a clinic/center provider located in Lancaster, South Carolina. 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	The Children's Clinic
Address	1228 Colonial Commons
City	Lancaster
State	SC
ZIP	29720
Taxonomy	Clinic/Center
NPI Enumerated	April 20, 2007

Payer Source	Total Paid
Medicaid	$8.4M
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…	69,770	$70	$4.6M
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…	6,110	$100	$586.2K
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…	5,370	$100	$536.8K
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	$90	$426.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,670	$100	$370.7K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	7,630	$40	$313K
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.	17,140	$20	$308.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,600	$110	$288.4K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	11,860	$10	$166.1K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	5,420	$30	$151.8K

Showing 1–10 of 57

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

The Children's Clinic — 6 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

57 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…	44	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…	22	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…	256	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…	40	380	160	$100	$226.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	37	390	100	$100	$148.3K
87081	The lab analyst cultures a patient specimen on a test medium designed to grow only a specific pathogenic organism.	19	90	720	$40	$110.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	37	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,…	131	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.	30	650	140	$30	$98.1K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	220	270	120	$50	$93.2K

Showing 1–10 of 57

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Chester-lancaster Disabilties & Special Needs Board	SC	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$13M
Medical University Hospital Authority	SC	General Acute Care Hospital	$0	$12.1M
Golden Care Inc	SC	Home Health Agency	$0	$7.1M
Mante Pediatrics LLC	SC	Pediatrics Physician	$0	$7M
Carolina Family Care, Inc	SC	Internal Medicine Physician	$0	$6.9M
Morphis Pediatric Group Of Lancaster, P.A.	SC	Rural Health Clinic/Center	$0	$4.8M
Medical University Hospital Authority	SC	Rural Health Clinic/Center	$0	$4.5M
Lancaster County School District	SC	Local Education Agency (LEA)	$0	$2.9M
Oscar Kuruvilla	SC	Ophthalmology Physician	$2.7M	$0
County Of Lancaster	SC	Land Ambulance	$963.3K	$1.5M

The Children's Clinic — Billing Profile & Reimbursement Data

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The 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