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

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

Thomas Jones (NPI 1386693158)

Field	Value
Entity Type	Individual
Organization	Thomas Jones
Address	14 Richland Medical Park Dr Ste 200
City	Columbia
State	SC
ZIP	29203
Taxonomy	Orthopaedic Surgery Physician
NPI Enumerated	May 9, 2006

Payer Source	Total Paid
Medicare	$4.3K
Medicaid	$0

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

4 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…	30	$60	$2K
72190	In this procedure, the provider takes a minimum three X–ray images of the pelvic bone to check for any fracture, swelling, or reason of pain in the pelvic area.	30	$30	$960
73552	In this diagnostic procedure, the provider takes an X–ray image of the femur (thigh bone) from a minimum of two projections (directions or angles) to check for fracture, swelling, or other reason for…	40	$20	$840
73600	In this procedure, the provider takes two X–ray views of the ankle joint to check for any fracture, swelling, or reason for pain in the ankle.	20	$20	$510

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. South Carolina Distribution

Thomas Jones — 0 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. state median

4 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99213	6,022	7,690	100	$60	$10.8K
73600	23	50	20	$20	$770
72190	5	20	30	$30	$760
73552	37	220	20	$10	$300

Thomas Jones — Billing Profile & Reimbursement Data

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Thomas Jones — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References