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

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

Ted James (NPI 1629058342)

Field	Value
Entity Type	Individual
Organization	Ted James
Address	880 W Central Rd Ste 5000
City	Arlington Heights
State	IL
ZIP	60005
Taxonomy	Surgery Physician
NPI Enumerated	January 19, 2006

Payer Source	Total Paid
Medicare	$14.9K
Medicaid	$0

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
19301	The provider removes a lesion, including surrounding margins, or a significant portion (a segment or quadrant) of the breast without removing the entire breast or lymph nodes.	20	$540	$8.7K
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…	20	$110	$2.5K
38525	The provider surgically removes the lymph nodes in the deep axilla through an open incision. He may send them to the laboratory for analysis. The provider performs the procedure as an investigation…	10	$200	$2.4K
38900	The provider injects a nonradioactive dye into the tissues surrounding the lymph nodes. The provider examines the lymph nodes during the procedure to detect the presence of disease and identify the…	10	$110	$1.4K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Illinois Distribution

Ted James — 0 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Illinois

Full comparison — all codes billed, vs. state median

4 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
19301	6	80	20	$540	$14.6K
99204	187	8,580	30	$110	$5.6K
38525	6	70	20	$230	$4.6K
38900	7	70	20	$120	$2.5K

Ted James — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References