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

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

Island Pediatrics Inc (NPI 1376978288)

Island Pediatrics Inc is a pediatric cardiology physician provider located in Hilo, Hawaii. This profile covers 0 Medicare and 17 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	Island Pediatrics Inc
Address	198 Ponahawai St
City	Hilo
State	HI
ZIP	96720
Taxonomy	Pediatric Cardiology Physician
NPI Enumerated	September 10, 2013

Payer Source	Total Paid
Medicaid	$314K
Medicare	$0

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

17 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…	2,240	$50	$100.8K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	510	$110	$54.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	460	$100	$47.5K
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…	390	$110	$42.8K
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…	390	$110	$42.4K
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,…	260	$30	$7.8K
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.	200	$20	$4.2K
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…	140	$20	$3K
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…	40	$80	$3K
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…	10	$230	$2.9K

Showing 1–10 of 17

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Island Pediatrics Inc — 0 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

17 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	180	710	650	$90	$274.1K
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…	605	690	650	$90	$235.4K
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…	58	60	650	$110	$152.2K
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,…	79	190	190	$100	$122.8K
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…	36	100	210	$120	$116.7K
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…	38	100	210	$110	$101.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	40	110	230	$90	$55.7K
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…	122	170	120	$70	$35.7K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	26	50	50	$40	$33.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	23	90	180	$70	$31.4K

Showing 1–10 of 17

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hilo Benioff Medical Center	HI	General Acute Care Hospital	$0	$51.2M
Liberty Dialysis - Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$19.3M
Metropacific Group, Corp	HI	Developmentally Disabled Services Day Training Agency	$0	$13.3M
Triple Ace Venture Capital, Corp.	HI	In Home Supportive Care Agency	$0	$10.5M
Whchc - Hawaii Island Community Health Center	HI	Federally Qualified Health Center (FQHC)	$0	$8.1M
West Hawaii Community Health Center, Inc.	HI	Federally Qualified Health Center (FQHC)	$0	$7.1M
Hilo Urgent Care Center, LLC	HI	Urgent Care Clinic/Center	$0	$6.5M
Alpha Care Hawaii LLC	HI	In Home Supportive Care Agency	$0	$5.9M
Mastercare Inc	HI	In Home Supportive Care Agency	$0	$5.4M
Americare Hawaii Incorporated	HI	In Home Supportive Care Agency	$0	$3.7M

Island Pediatrics Inc — Billing Profile & Reimbursement Data

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Island Pediatrics Inc — 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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