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

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

Hilo Urgent Care Center, LLC (NPI 1487750089)

Key Findings

Field	Value
Entity Type	Organization
Organization	Hilo Urgent Care Center, LLC
Address	670 Kekuanaoa St
City	Hilo
State	HI
ZIP	96720
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	September 15, 2006

Payer Source	Total Paid
Medicaid	$6.5M
Medicare	$0

This provider is effectively single‑payer on record: there is no Medicare billing on file and the practice reports Total Medicaid revenue: $6.5M. The absence of Medicare claims suggests the entity operates primarily within the Medicaid market rather than serving a mixed Medicare/Medicaid patient panel.

Revenue is highly concentrated among a few codes: the precomputed top 3 Medicaid codes by revenue account for 65.0% of this provider's total Medicaid revenue. Specifically, 99214 accounts for $2.3M (35.3%), 87502 for $999.4K (15.3%), and 99203 for $944.3K (14.4%), indicating a small set of services drives the majority of billed Medicaid dollars.

The code mix signals an urgent care–style operating model: high volumes of E/M visits for both established and new patients (99214 with 34.4K claims and 99203 with 15.5K claims) combined with the facility/urgent care add-on S9088 (57.4K claims) point to walk‑in clinic throughput rather than primary care longitudinal management. Extensive respiratory infectious disease testing is present as well, with 87502 (11.4K claims) and 87635 (13.5K claims) among the top revenue drivers, consistent with urgent‑care demand for influenza and SARS‑CoV‑2 diagnostics.

This provider is a dominant statewide performer for multiple high‑volume codes. 99203 ranks #1 of 171 providers in-state (100th percentile; described as an extreme outlier), S9088 ranks #1 of 38 providers (100th percentile; extreme outlier), and 99214 ranks #9 of 690 providers (99th percentile; extreme outlier), demonstrating market share concentration in urgent care E/M encounters relative to peers.

Several lab and respiratory testing codes show large absolute claim volumes and above‑peer rankings, but mixed descriptive labels: 87502 (11.4K claims, $999.4K revenue) ranks #2 of 32 in-state (97th percentile; notably above typical state volume), while 87635 (13.5K claims, $609K revenue) ranks #2 of 46 (98th percentile) yet is described as typical, unremarkable volume. These patterns indicate the practice is a major testing site for infectious respiratory illness in-state, even where some comparisons are characterized as typical.

Operational detail visible in the billing record shows S9088 (urgent care services) generated $861.3K (13.2% of Medicaid revenue) from 57.4K claims, underscoring a high‑throughput urgent care billing model that relies on many brief encounters. The combination of modest per‑claim paid amounts (e.g., $15 avg for S9088, $67 avg for 99214) with very high claim counts suggests volume, not high unit prices, drives revenue.

There are several injectable drug codes with claims but no recorded paid revenue on file (J1885: 264 claims, $0 revenue; J2930: 33 claims, $0 revenue; J1100: 224 claims, $0 revenue), which may reflect payer adjudication/pricing policies or bundling of those services into visit payments rather than standalone reimbursement. These zero‑paid drug lines are present but represent immaterial share of the reported Medicaid revenue.

Tenure and market presence are long established: NPI enumerated (registered): 2006-09-15 (~20 years ago). The two decades of enumeration combined with extreme‑outlier volume in several urgent care and testing codes indicate sustained operation and likely entrenched referral or walk‑in patient flows in the HILO, HI market.

Medicaid: Complete Services Breakdown

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

21 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…	34,430	$70	$2.3M
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	11,360	$90	$999.4K
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…	15,480	$60	$944.3K
S9088	Services provided in an urgent care center (list in addition to code for service)	57,420	$20	$861.3K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	13,530	$50	$609K
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…	8,700	$50	$400.1K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	9,120	$30	$309.9K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	1,170	$40	$50.5K
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…	200	$100	$20.5K
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…	2,870	$10	$14.3K

Showing 1–10 of 21

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Hilo Urgent Care Center, LLC — 5 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

21 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…	51	710	650	$90	$274.1K
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…	9	690	650	$90	$235.4K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	2	30	1,040	$50	$157.3K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	2	50	980	$30	$111.1K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	2	20	850	$50	$89.6K
S9088	Services provided in an urgent care center (list in addition to code for service)	1	40	1,230	$10	$65.9K
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…	1	170	120	$70	$35.7K
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…	50	170	70	$90	$23.3K
87634	The lab analyst performs a test for respiratory syncytial virus (RSV) antigen detection using amplified nucleic acid probe technique.	8	10	310	$30	$21.6K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	8	70	80	$60	$20.6K

Showing 1–10 of 21

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Stephen Warsh	HI	General Practice Physician	$61.2K	$0
Lorraine Sonoda-fogel	HI	Internal Medicine Physician	$33.3K	$0
Katelyn Steele	HI	Family Medicine Physician	$30.2K	$0
Lokenani Souza	HI	Nurse Practitioner	$27.4K	$0
Leilani Aldrich	HI	Nurse Practitioner	$23.1K	$0
Hart Miller	HI	Adult Medicine Physician	$19.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hilo Benioff Medical Center	HI	General Acute Care Hospital	$0	$51.2M
Liberty Dialysis - Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$19.3M
Metropacific Group, Corp	HI	Developmentally Disabled Services Day Training Agency	$0	$13.3M
Triple Ace Venture Capital, Corp.	HI	In Home Supportive Care Agency	$0	$10.5M
Whchc - Hawaii Island Community Health Center	HI	Federally Qualified Health Center (FQHC)	$0	$8.1M
West Hawaii Community Health Center, Inc.	HI	Federally Qualified Health Center (FQHC)	$0	$7.1M
Alpha Care Hawaii LLC	HI	In Home Supportive Care Agency	$0	$5.9M
Mastercare Inc	HI	In Home Supportive Care Agency	$0	$5.4M
Americare Hawaii Incorporated	HI	In Home Supportive Care Agency	$0	$3.7M
Garret K. Uehara, Dds Inc. Dba	HI	General Practice Dentistry	$0	$3.6M

Hilo Urgent Care Center, LLC — Billing Profile & Reimbursement Data

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Hilo Urgent Care Center, LLC — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References