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.

Elite Pain Management, LLC (NPI 1457727752)

Elite Pain Management, LLC is a pain medicine physician provider located in Little River, South Carolina. This profile covers 0 Medicare and 16 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	Elite Pain Management, LLC
Address	4237 River Hills Dr
City	Little River
State	SC
ZIP	29566
Taxonomy	Pain Medicine Physician
NPI Enumerated	August 20, 2015

Payer Source	Total Paid
Medicaid	$1.6M
Medicare	$0

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	8,950	$60	$492.3K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	7,140	$60	$442.4K
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…	13,500	$30	$405K
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…	4,450	$50	$200K
99204	The provider sees a new 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 provider…	480	$70	$34.6K
64493	The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance…	180	$40	$6.6K
64495	In this add–on procedure, the provider injects a diagnostic or therapeutic substance into a lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint,…	180	$20	$3.2K
64494	In this add–on procedure, the provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that…	180	$20	$3.2K
J1030	Injection, methylprednisolone acetate, 40 mg	760	$1	$2.3K
64635	Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue.	60	$40	$2.2K

Showing 1–10 of 16

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

Elite Pain Management, LLC — 1 of 16 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

16 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…	189	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…	350	2,480	350	$80	$246K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	18	160	1,480	$30	$126.4K
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.	304	380	660	$30	$90K
99204	The provider sees a new 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 provider…	104	490	90	$100	$63.6K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	3	60	300	$40	$60K
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	160	300	110	$10	$11.7K
64493	The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance…	8	20	80	$40	$9.8K
64635	Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue.	5	10	70	$40	$5.2K
64495	In this add–on procedure, the provider injects a diagnostic or therapeutic substance into a lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint,…	5	10	70	$20	$3.6K

Showing 1–10 of 16

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Elite Pain Management, LLC	MO	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$0	$3.5M
David Tonkin	MO	Interventional Pain Medicine Physician	$367.4K	$91.2K
Alok Jain	MO	Psychiatry Physician	$21.6K	$157.2K
James Sigler	KS	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$63.8K	$0
Amanda Gilbert	MO	Psychiatric/Mental Health Nurse Practitioner	$11.7K	$2.1K

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
Mcleod Physician Associates	SC	Obstetrics & Gynecology Physician	$0	$2.6M
Sr Plus Behavior Consultants, Inc.	SC	Behavior Analyst	$0	$2.5M
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

Elite Pain Management, LLC — Billing Profile & Reimbursement Data

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Elite Pain Management, 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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