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

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

Pediatric Urgent Care PA (NPI 1598059776)

Pediatric Urgent Care PA is a urgent care clinic/center provider located in The Woodlands, Texas. This profile covers 0 Medicare and 34 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	Pediatric Urgent Care PA
Address	1640 Lake Woodlands Dr
City	The Woodlands
State	TX
ZIP	77380
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	June 5, 2011

Payer Source	Total Paid
Medicaid	$25.2M
Medicare	$0

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

34 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S9083	Global fee urgent care centers	97,920	$90	$9.1M
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…	69,800	$90	$6M
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…	36,700	$70	$2.7M
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…	31,160	$70	$2.2M
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	83,760	$30	$2.1M
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…	17,270	$100	$1.7M
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	65,250	$10	$522K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	50,290	$10	$402.3K
G2023	Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source	50,720	$10	$304.3K
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…	4,630	$20	$106.5K

Showing 1–10 of 34

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Texas Distribution

Pediatric Urgent Care PA — 11 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Texas

Full comparison — all codes billed, vs. Texas median

34 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S9083	Global fee urgent care centers	1	30	210	$100	$822K
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…	175	6,040	710	$40	$232.8K
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…	29	5,810	540	$50	$155.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,326	1,540	360	$80	$110.6K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	7	1,350	320	$30	$101.2K
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…	356	850	260	$40	$77.5K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	1,325	1,920	220	$30	$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…	5	1,860	130	$70	$65.4K
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…	5	1,520	100	$80	$50.1K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	21	1,850	510	$10	$48.3K

Showing 1–10 of 34

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Maxim Healthcare Services, Inc.	TX	Home Health Agency	$0	$19M
Shaun S. Varghese, M.d., PLLC	TX	Neurology with Special Qualifications in Child Neurology Physician	$0	$16.8M
Singleton Associates PA	TX	Diagnostic Radiology Physician	$0	$16.2M
Guy Burrows	TX	Neurology Physician	$11.3M	$0
Trifecta Pharmacy LLC	TX	Community/Retail Pharmacy	$7.9M	$1.3K
Samir Shirodkar	TX	Urology Physician	$3.4M	$0
Randall Johnson	TX	Rheumatology Physician	$2.5M	$0
Wise Diagnostic Systems, LLC	TX	Clinical Medical Laboratory	$2M	$451.8K
Asit Choksi	TX	Medical Oncology Physician	$2.4M	$0
Carolyn Chen	TX	Ophthalmology Physician	$2M	$0

Pediatric Urgent Care PA — Billing Profile & Reimbursement Data

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Pediatric Urgent Care PA — 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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