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

Why is the Medicaid comparison limited to Utah 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. Utah (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.

Sunnyside Pediatrics (NPI 1275940611)

Sunnyside Pediatrics is a primary care clinic/center provider located in Salt Lake City, Utah. This profile covers 0 Medicare and 34 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	Sunnyside Pediatrics
Address	1060 E 100 S
City	Salt Lake City
State	UT
ZIP	84102
Taxonomy	Primary Care Clinic/Center
NPI Enumerated	July 17, 2014

Payer Source	Total Paid
Medicaid	$828.5K
Medicare	$0

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

34 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…	6,740	$70	$437.8K
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…	1,720	$80	$135.7K
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…	1,480	$70	$106.5K
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…	720	$80	$58.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	750	$50	$38.7K
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.	530	$30	$15.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	230	$50	$10.2K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	7,310	$1	$7.3K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	1,750	$1	$7K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	3,510	$1	$3.5K

Showing 1–10 of 34

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Sunnyside Pediatrics — 2 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

34 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	382	1,340	200	$80	$144K
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…	71	1,360	190	$70	$125K
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…	29	220	200	$80	$74K
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…	22	190	150	$80	$58.1K
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,…	167	170	80	$100	$35.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	24	150	60	$70	$32.2K
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.	12	50	110	$30	$31.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	30	90	90	$60	$22.4K
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…	36	60	100	$40	$18.3K
81002	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dip stick, and shakes off the excess urine. Alternatively, the analyst may place drops of the urine specimen…	20	50	160	$10	$17.5K

Showing 1–10 of 34

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Emergency Physicians Integrated Care, LLC	UT	Emergency Medicine Physician	$0	$31.2M
Helping Hand Association	UT	Substance Abuse Rehabilitation Facility	$0	$18.4M
House Of Hope	UT	Substance Abuse Rehabilitation Facility	$0	$11.6M
Odyssey House Inc	UT	Family Medicine Physician	$0	$10.1M
Salt Lake Regional Medical Center LP	UT	General Acute Care Hospital	$0	$9.8M
Lyssa Inc	UT	Ambulatory Surgical Clinic/Center	$0	$7.2M
First Step House	UT	Clinical Medical Laboratory	$0	$2.3M
Planned Parenthood Association Of Utah	UT	Voluntary or Charitable Agency	$0	$1.4M
University Of Utah Behavioral Health Services	UT	Psychiatry Physician	$0	$1.3M
S-h Opco Salt Lake City, LLC	UT	Assisted Living Facility	$0	$879.2K

Sunnyside Pediatrics — Billing Profile & Reimbursement Data

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Sunnyside 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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Frequently Asked Questions

References