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

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

Lehigh Valley Physician Group (NPI 1396829685)

Lehigh Valley Physician Group is a pediatrics physician provider located in Allentown, Pennsylvania. This profile covers 0 Medicare and 62 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	Lehigh Valley Physician Group
Address	401 N 17th St
City	Allentown
State	PA
ZIP	18104
Taxonomy	Pediatrics Physician
NPI Enumerated	October 24, 2006

Payer Source	Total Paid
Medicaid	$7.6M
Medicare	$0

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

62 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…	41,780	$50	$2.2M
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…	15,120	$90	$1.4M
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…	14,270	$100	$1.4M
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…	8,340	$80	$667.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7,500	$90	$660K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,760	$90	$239.9K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	2,110	$70	$150K
92551	The provider delivers a limited series of tones or sounds to a patient to determine if the patient’s hearing is in an acceptable range to detect hearing problems.	13,530	$10	$135.3K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	2,040	$50	$102K
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…	10,180	$10	$91.6K

Showing 1–10 of 62

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Lehigh Valley Physician Group — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

62 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	1,556	1,690	760	$170	$1.2M
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…	7	820	230	$80	$71.7K
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…	196	8,160	210	$60	$68.4K
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…	7	660	180	$70	$63.7K
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…	33	8,870	240	$40	$56.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	13	870	160	$70	$48.2K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	1,076	1,210	100	$90	$45K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	222	410	320	$10	$37.4K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	7	100	70	$60	$34.8K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	21	730	90	$70	$31.5K

Showing 1–10 of 62

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lehigh Valley Hospital	PA	General Acute Care Hospital	$0	$64.3M
Lehigh Valley Physician Group	PA	Family Medicine Physician	$0	$21.9M
Lehigh Valley Physician Group	PA	Emergency Medicine Physician	$0	$16.3M
Lehigh Valley Hospital Pocono	PA	General Acute Care Hospital	$0	$11.9M
Family Care Centers Inc.	PA	Internal Medicine Physician	$0	$11.1M
Hazleton Professional Services	PA	Internal Medicine Physician	$0	$8.3M
Family Care Centers Inc	PA	Family Medicine Physician	$0	$6.1M
Lehigh Valley Physician Group	PA	Pediatric Emergency Medicine (Emergency Medicine) Physician	$0	$5.9M
Eugene Grady	PA	Rheumatology Physician	$1.7M	$980
Joseph Zaladonis	PA	Specialist	$1.4M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St. Luke's Hospital	PA	General Acute Care Hospital	$0	$23.4M
Loving Care Agency, Inc.	PA	Home Health Agency	$0	$21.2M
The Salvation Army	PA	Nursing Care Agency	$0	$17.9M
Maxim Healthcare Services, Inc.	PA	Home Health Agency	$0	$16M
Valley Health Partners Community Health Center	PA	Federally Qualified Health Center (FQHC)	$0	$11.9M
Pyramid Healthcare Inc.	PA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$11M
Horizon House, Inc.	PA	Community/Behavioral Health Agency	$0	$8.2M
Cetronia Ambulance Corps, Inc	PA	Land Ambulance	$1.7M	$4.3M
Alan Listhaus	PA	Ophthalmology Physician	$2.6M	$0
Surgery Center Of Allentown LLC	PA	Ambulatory Surgical Clinic/Center	$2M	$0

Lehigh Valley Physician Group — Billing Profile & Reimbursement Data

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Lehigh Valley Physician Group — 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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