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

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

Valley Children's Medical Group (NPI 1437555265)

Valley Children's Medical Group is a pediatrics physician provider located in Modesto, California. This profile covers 0 Medicare and 171 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	Valley Children's Medical Group
Address	1524 Mchenry Ave
City	Modesto
State	CA
ZIP	95350
Taxonomy	Pediatrics Physician
NPI Enumerated	November 5, 2014

Payer Source	Total Paid
Medicaid	$65M
Medicare	$0

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

171 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…	148,300	$70	$10.7M
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…	82,700	$120	$10.1M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	88,250	$60	$5.3M
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	56,800	$80	$4.8M
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…	80,770	$40	$3.5M
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	42,370	$60	$2.4M
93304	The provider performs a limited or follow–up transthoracic echocardiography to obtain images of the heart through the chest wall in patients born with heart defects. It is a limited examination of a…	28,250	$50	$1.5M
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	25,670	$50	$1.3M
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	16,770	$70	$1.2M
Z0102	N/A	5,740	$190	$1.1M

Showing 1–10 of 171

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. California Distribution

Valley Children's Medical Group — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — California

Full comparison — all codes billed, vs. California median

171 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	30	1,570	680	$110	$1.1M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	254	1,300	510	$100	$943K
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	117	1,400	470	$80	$884.5K
99281	The provider sees a patient for the lowest level emergency department visit.	404	430	1,140	$90	$769.9K
Z0102	N/A	4	40	1,740	$210	$562.8K
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	8	50	1,160	$240	$473.1K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	7	60	1,070	$140	$402.6K
Z0104	N/A	9	40	1,130	$160	$379K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	11	140	590	$120	$350.5K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	8	30	520	$230	$337.4K

Showing 1–10 of 171

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
John Saito	CA	Pediatric Pulmonology Physician	$468.7K	$6.5M
Dexter Estrada	CA	Hematology & Oncology Physician	$5.6M	$0
Steven Hager	CA	Hematology & Oncology Physician	$3.6M	$0
Christine Chang-halpenny	CA	Radiation Oncology Physician	$1M	$0
Nadeem Rahman	CA	Urology Physician	$556.4K	$910
Thomas Minor	CA	Urology Physician	$513.9K	$0
Ariel Hurtado	CA	Anesthesiology Physician	$252.9K	$0
Dhiraj Jeyanandarajan	CA	Neurology Physician	$226.2K	$0
Mark Bernard	CA	Nuclear Medicine Physician	$167K	$0
George Lui	CA	Adult Congenital Heart Disease Physician	$87.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Doctors Medical Center Of Modesto, Inc.	CA	General Acute Care Hospital	$0	$101.2M
Golden Valley Health Centers	CA	Internal Medicine Physician	$0	$79.4M
Northern California Cancer Center	CA	Medical Oncology Physician	$0	$40M
County Of Stanislaus	CA	Clinic/Center	$0	$27.4M
Cep America - California	CA	Emergency Medicine Physician	$0	$26.1M
Modesto Radiology Imaging, Inc.	CA	Diagnostic Radiology Physician	$2.3M	$10.7M
Khosrow Mehrany	CA	Specialist	$7.7M	$0
Aegis Treatment Centers, LLC	CA	Methadone Clinic	$780.3K	$23.7K
Thomas Wallace	CA	Critical Care Medicine (Internal Medicine) Physician	$634.3K	$0
Joselyn Deculing	CA	Nurse Practitioner	$566.2K	$0

Valley Children's Medical Group — Billing Profile & Reimbursement Data

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Valley Children's Medical 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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