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

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

Pediatric Cardiology Assoc PA (NPI 1346311925)

Pediatric Cardiology Assoc PA is a pediatric cardiology physician provider located in Scarborough, Maine. This profile covers 0 Medicare and 14 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	Pediatric Cardiology Assoc PA
Address	71 Us Route 1
City	Scarborough
State	ME
ZIP	04074
Taxonomy	Pediatric Cardiology Physician
NPI Enumerated	November 13, 2006

Payer Source	Total Paid
Medicaid	$518K
Medicare	$0

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
93325	The provider performs Doppler echocardiography, a diagnostic procedure based on the Doppler effect of sound, color flow velocity mapping, a two–dimensional image representation of blood flow in the…	1,610	$70	$117.4K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	340	$210	$71.7K
93304	The provider performs a limited or follow–up transthoracic echocardiography to obtain images of the heart through the chest wall in patients born with heart defects. It is a limited examination of a…	490	$130	$65.1K
93000	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	1,230	$40	$44.1K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	130	$340	$43.5K
93321	The provider performs Doppler echocardiography using pulsed wave and/or continuous wave with a spectral display for a follow–up or limited study. The ultrasound involves the continuous generation of…	790	$50	$42.4K
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…	270	$130	$35.4K
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…	300	$90	$27.4K
93320	The provider performs a complete Doppler echocardiography, which uses high–frequency sound waves to create a two–dimensional image of the heart, while the use of Doppler technology allows…	360	$80	$27.3K
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…	250	$80	$19.3K

Showing 1–10 of 14

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Pediatric Cardiology Assoc PA — 1 of 14 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

14 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	36	40	1,830	$90	$292.9K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	3	10	280	$200	$251.2K
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…	326	460	1,240	$30	$190K
93304	The provider performs a limited or follow–up transthoracic echocardiography to obtain images of the heart through the chest wall in patients born with heart defects. It is a limited examination of a…	4	10	770	$180	$166.6K
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…	332	480	1,030	$20	$128.9K
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…	137	150	150	$60	$37.6K
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…	41	40	80	$70	$30.2K
93308	The provider performs a limited or follow–up transthoracic echocardiography to obtain a two dimensional (2D) image of the heart through the chest wall. It is a limited examination of a focused…	7	10	130	$100	$30K
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…	79	170	220	$30	$24.4K
93325	The provider performs Doppler echocardiography, a diagnostic procedure based on the Doppler effect of sound, color flow velocity mapping, a two–dimensional image representation of blood flow in the…	5	10	520	$10	$13.8K

Showing 1–10 of 14

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nordx	ME	Clinical Medical Laboratory	$2.4M	$21.8M
New England Life Care, Inc.	ME	Home Infusion Therapy Pharmacy	$0	$12.4M
Northeast Mobile Health Services	ME	Ambulance	$930.3K	$9.5M
Choices Are For Everyone, Inc.	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$9.7M
Skilled Care Solutions	ME	Home Health Agency	$0	$6.8M
Surgi-care, Inc	ME	Prosthetic/Orthotic Supplier	$0	$5.6M
Mainehealth	ME	Family Medicine Physician	$0	$5M
Mainehealth	ME	Neurology Physician	$0	$4.2M
Mainehealth	ME	Cardiovascular Disease Physician	$0	$3.9M
Maine Home Care Solutions	ME	In Home Supportive Care Agency	$0	$3.2M

Pediatric Cardiology Assoc PA — Billing Profile & Reimbursement Data

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Pediatric Cardiology Assoc PA — 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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