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.

Rafael Figueroa (NPI 1205972742)

Rafael Figueroa is a specialist provider located in Caguas, Puerto Rico. This profile covers 0 Medicare and 9 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	Individual
Organization	Rafael Figueroa
Address	114 Suite L Munoz Marin
City	Caguas
State	PR
ZIP	00726
Taxonomy	Specialist
NPI Enumerated	January 30, 2007

Payer Source	Total Paid
Medicaid	$731.1K
Medicare	$0

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	6,990	$70	$489.3K
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…	1,690	$80	$130.1K
99205	The provider sees a new 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 provider…	1,100	$90	$103.2K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	20	$190	$3.2K
99204	The provider sees a new 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 provider…	20	$70	$1.6K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	50	$30	$1.6K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	20	$80	$1.3K
76818	The provider performs a biophysical profile test to measure the health of the baby during pregnancy. The test consists of a nonstress test and an ultrasound.	10	$70	$780
88142	The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer…	60	$1	$60

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

Rafael Figueroa — 0 of 9 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

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
88142	The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer…	39	50	370	$20	$247.3K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	372	390	290	$80	$96.8K
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…	16	280	210	$30	$43.8K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	459	500	130	$90	$43.1K
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…	169	900	360	$30	$42.5K
99205	The provider sees a new 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 provider…	17	160	90	$90	$31.8K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	16	20	190	$20	$26.3K
99204	The provider sees a new 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 provider…	421	530	100	$70	$22.9K
76818	The provider performs a biophysical profile test to measure the health of the baby during pregnancy. The test consists of a nonstress test and an ultrasound.	13	10	40	$80	$21.5K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sandra Gracia-lopez	PR	Nuclear Medicine Physician	$26.7K	$4.1M
Hector Velez Cortes	PR	Hematology & Oncology Physician	$4.3K	$4M
Hiram Ortega	PR	Gastroenterology Physician	$8.8K	$3.1M
Nelson Medina	PR	Gastroenterology Physician	$1.5K	$2.7M
Eduardo Perez Rodriguez	PR	Ophthalmology Physician	$21.7K	$2.3M
Santa Merle	PR	Hematology & Oncology Physician	$4.5K	$2M
Amarilys Santiago Rolon	PR	Gastroenterology Physician	$510	$1.6M
Harry Alverio Rodriguez	PR	Physical Medicine & Rehabilitation Physician	$3.7K	$1.5M
Adalberto Mendoza	PR	Anatomic Pathology & Clinical Pathology Physician	$13.3K	$1.5M
Luz Butler Moya	PR	Physical Therapist	$0	$1.5M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jose Diaz-abascal	PR	Oral and Maxillofacial Surgery (Dentist)	$0	$3.8M
David Vazquez-morales	PR	Oral and Maxillofacial Surgery (Dentist)	$0	$3.1M
Inspira Behavioral Care Corp.	PR	Adult Mental Health Clinic/Center	$0	$1.7M
Benigno Lopez	PR	Orthopaedic Surgery Physician	$0	$1.3M
St Lukes Episcopal Church Home Care Program	PR	Home Health Agency	$0	$1.1M
Hector Ramos-fuentes	PR	Oral and Maxillofacial Surgery (Dentist)	$0	$656.4K
Elissa Carrera Gonzalez	PR	Internal Medicine Physician	$24K	$0
Luis Ferrer Torres	PR	Anatomic Pathology & Clinical Pathology Physician	$9.1K	$0
Armando Sanchez Burgos	PR	General Practice Physician	$5.1K	$0

Rafael Figueroa — Billing Profile & Reimbursement Data

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Rafael Figueroa — 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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