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

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

Premier Pediatrics LLC (NPI 1427115187)

Premier Pediatrics LLC is a pediatrics physician provider located in Cedar City, Utah. This profile covers 0 Medicare and 36 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	Premier Pediatrics LLC
Address	1251 Northfield Rd
City	Cedar City
State	UT
ZIP	84720
Taxonomy	Pediatrics Physician
NPI Enumerated	January 2, 2007

Payer Source	Total Paid
Medicaid	$1.1M
Medicare	$0

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

36 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	5,020	$90	$446.4K
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…	3,790	$60	$239K
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…	1,350	$100	$130K
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…	1,200	$100	$121.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,030	$90	$97.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	370	$100	$36.7K
97802	The provider treats medical conditions and related symptoms using specific diet therapy by interacting individually with the patient. This code represents each 15 minutes of the first visit with the…	860	$1	$3.4K
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…	350	$10	$3.2K
90723	The provider administers a combination inactivated vaccine intramuscularly to prevent multiple diseases, including diphtheria, tetanus, acellular pertussis, hepatitis B, and polio.	340	$1	$670
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	660	$1	$660

Showing 1–10 of 36

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Premier Pediatrics LLC — 1 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

36 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	64	120	1,100	$30	$186.6K
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…	74	1,340	200	$80	$144K
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…	118	1,360	190	$70	$125K
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…	140	160	250	$50	$76.9K
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	220	200	$80	$74K
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…	30	190	150	$80	$58.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	15	150	60	$70	$32.2K
97802	The provider treats medical conditions and related symptoms using specific diet therapy by interacting individually with the patient. This code represents each 15 minutes of the first visit with the…	2	10	50	$110	$28.3K
36416	In this procedure, the provider pricks the patient’s finger, heel, or ear with a pointed instrument and collects specimen of droplets of blood by pressing the pricking site.	2	70	290	$20	$27.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	19	90	90	$60	$22.4K

Showing 1–10 of 36

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Robert Dowse	UT	Pediatrics Physician	$0	$867K
Daniel Corry	UT	Medical Physician Assistant	$165.6K	$1.3K
Chad Coon	ID	Physician Assistant	$28.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tyler Albrecht	UT	Pediatric Dentistry	$0	$2.8M
Ihc Health Services Inc	UT	Multi-Specialty Clinic/Center	$0	$1.6M
Color Country Pediatrics, LLC	UT	Pediatrics Physician	$0	$1.3M
Pinnacle Youth Services, Inc	UT	Community/Behavioral Health Agency	$0	$1.3M
Iron County School District	UT	Local Education Agency (LEA)	$0	$1.3M
Southern Utah University	UT	Developmentally Disabled Services Day Training Agency	$0	$1.2M
Children's Dental Of Cedar City	UT	Pediatric Dentistry	$0	$1.1M
Kirk Anderton	UT	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$798.4K
Cedar Ridge Family Medicine	UT	Family Medicine Physician	$0	$762.4K
Ihc Health Services Inc	UT	Emergency Medicine Physician	$0	$723.4K

Premier Pediatrics LLC — Billing Profile & Reimbursement Data

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Premier Pediatrics LLC — 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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