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.

Mcleod Physician Associates (NPI 1396031985)

Mcleod Physician Associates is a obstetrics & gynecology physician provider located in Little River, South Carolina. This profile covers 0 Medicare and 26 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	Mcleod Physician Associates
Address	3980 Highway 9 E
City	Little River
State	SC
ZIP	29566
Taxonomy	Obstetrics & Gynecology Physician
NPI Enumerated	June 22, 2011

Payer Source	Total Paid
Medicaid	$2.6M
Medicare	$0

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

26 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…	24,260	$60	$1.5M
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	2,870	$80	$229.4K
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…	1,950	$80	$163.8K
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,…	2,900	$40	$107.1K
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	1,310	$80	$106.2K
76805	In this procedure, the provider performs an ultrasound of a pregnant uterus for examination of the first or a single fetus and to examine the mother after the first trimester, or more than 14 weeks…	960	$100	$97K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	3,670	$30	$91.7K
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…	24,910	$1	$74.7K
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…	880	$80	$73.2K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	830	$90	$71.9K

Showing 1–10 of 26

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Carolina Distribution

Mcleod Physician Associates — 2 of 25 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. South Carolina median

26 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…	107	2,770	210	$60	$254.5K
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…	631	2,480	350	$80	$246K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	14	100	240	$100	$187.3K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	65	410	330	$50	$152.6K
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,…	54	610	190	$50	$98.4K
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.	258	270	120	$50	$93.2K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	64	380	660	$30	$90K
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	13	20	1,080	$1	$72.5K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	17	120	300	$40	$67.1K
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…	76	520	70	$70	$67.1K

Showing 1–10 of 26

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mcleod Physician Associates Ii	SC	Pediatrics Physician	$0	$13.1M
Mcleod Physician Associates Ii	SC	Obstetrics & Gynecology Physician	$0	$6.4M
Mcleod Physician Associates Ii	SC	Pediatrics Physician	$0	$6.1M
Mcleod Physician Associates Ii	SC	Pediatric Cardiology Physician	$0	$4.2M
Mcleod Physician Associates Ii	SC	Urgent Care Clinic/Center	$0	$4.2M
Dillon Family Medicine, P.A.	SC	Family Medicine Physician	$0	$4M
Mcleod Physician Associates Ii	SC	Gynecology Physician	$0	$2.6M
Mcleod Physician Associates Ii	SC	Obstetrics & Gynecology Physician	$0	$2.5M
Mcleod Physician Associates Ii	SC	Urgent Care Clinic/Center	$0	$2.3M
Mcleod Physician Associates Ii	SC	Cardiovascular Disease Physician	$0	$2.2M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Little River Medical Center Inc	SC	Federally Qualified Health Center (FQHC)	$0	$8M
Robert Prinzi	SC	Retina Specialist (Ophthalmology) Physician	$5.7M	$0
Little River Medical Center Inc	SC	Dentist	$0	$4M
Sr Plus Behavior Consultants, Inc.	SC	Behavior Analyst	$0	$2.5M
Elite Pain Management, LLC	SC	Pain Medicine Physician	$0	$1.6M
Timothy Gajewski	SC	Urology Physician	$554.7K	$0
Alex Mcgaughy	SC	Ophthalmology Physician	$543.4K	$0
Christopher Walsh	SC	Orthopaedic Surgery Physician	$470.1K	$0
Thirston Phillips	SC	Physical Medicine & Rehabilitation Physician	$454.1K	$0
Lisa Mount	SC	Internal Medicine Physician	$444K	$0

Mcleod Physician Associates — Billing Profile & Reimbursement Data

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Mcleod Physician Associates — 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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