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

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

John Higgins (NPI 1639241409)

Field	Value
Entity Type	Individual
Organization	John Higgins
Address	55 Fruit St
City	Boston
State	MA
ZIP	02114
Taxonomy	Clinical Pathology/Laboratory Medicine Physician
NPI Enumerated	November 15, 2006

Payer Source	Total Paid
Medicare	$8.1K
Medicaid	$0

Medicare: Complete Services Breakdown

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

2 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
85390	A physician or nonphysician lab professional provides interpretation and report of lab tests to evaluate fibrinolysis and coagulation.	270	$30	$7.9K
83020	The lab analyst records and calculates the hemoglobin fractions in a whole blood sample demonstrated by this hemoglobin fractionation test by electrophoresis.	20	$20	$260

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Massachusetts Distribution

John Higgins — 0 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. state median

2 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
85390	4	10	90	$30	$10.4K
83020	9	10	20	$10	$640

John Higgins — Billing Profile & Reimbursement Data

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John Higgins — 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