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

Why is the Medicaid comparison limited to 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. 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.

Pedsplus Urgent Care, LLC (NPI 1275087553)

Pedsplus Urgent Care, LLC is a urgent care clinic/center provider located in Fredericksburg, Virginia. This profile covers 0 Medicare and 65 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	Pedsplus Urgent Care, LLC
Address	2565 Cowan Blvd
City	Fredericksburg
State	VA
ZIP	22401
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	August 4, 2016

Payer Source	Total Paid
Medicaid	$11M
Medicare	$0

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

65 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	24,330	$80	$1.9M
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	24,290	$60	$1.4M
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	16,900	$70	$1.2M
87634	The lab analyst performs a test for respiratory syncytial virus (RSV) antigen detection using amplified nucleic acid probe technique.	16,880	$60	$978.9K
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…	15,610	$50	$842.7K
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…	7,180	$100	$703.4K
U0004	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by…	12,980	$50	$675.1K
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,…	21,480	$30	$536.9K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	13,660	$30	$382.4K
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	1,410	$260	$366.3K

Showing 1–10 of 65

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Pedsplus Urgent Care, LLC — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

65 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0033	Oral medication administration, direct observation	4	10	120	$140	$2M
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…	96	3,520	370	$70	$280.7K
S9088	Services provided in an urgent care center (list in addition to code for service)	14	20	850	$10	$270.1K
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…	207	4,010	290	$50	$199.8K
87801	The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique.	9	20	350	$30	$170.5K
U0004	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by…	2	30	3,050	$30	$120.8K
94640	The provider administers oxygen under pressure or not under pressure to open obstructed air passages. He uses any of the listed devices to treat a patient with an acute obstruction of the airway that…	53	210	390	$50	$106.2K
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…	22	970	100	$100	$87.1K
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…	49	1,000	100	$70	$81.1K
87631	The lab analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus,…	7	30	190	$30	$78.1K

Showing 1–10 of 65

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rappahannock Area Community Services Board	VA	Community/Behavioral Health Agency	$0	$142.5M
Mary Washington Hospital Inc.	VA	General Acute Care Hospital	$0	$80.1M
Paragon Autism Services, LLC	VA	Behavior Analyst	$0	$21.6M
Fredericksburg Emergency Medical Alliance, Inc.	VA	Emergency Medicine Physician	$0	$15M
Mary Washington Healthcare Physicians	VA	Family Medicine Physician	$0	$13.3M
Preferred Pediatrics At Snowden	VA	Pediatrics Physician	$0	$6.4M
Sunny Home Care Inc.	VA	Home Health Agency	$0	$6.3M
Thomas Johnson	VA	Retina Specialist (Ophthalmology) Physician	$3.6M	$0
Central Virginia Surgi-center LP	VA	Ambulatory Surgical Clinic/Center	$3.2M	$318.9K
Eric Lee	VA	Retina Specialist (Ophthalmology) Physician	$2.6M	$0

Pedsplus Urgent Care, LLC — Billing Profile & Reimbursement Data

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Pedsplus Urgent Care, 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

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