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

Why is the Medicaid comparison limited to Florida 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. Florida (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 Otolaryngology Head And Neck Surgeyr Assoc. PA (NPI 1639285513)

Pediatric Otolaryngology Head And Neck Surgeyr Assoc. PA is a specialist provider located in St Petersburg, Florida. This profile covers 0 Medicare and 30 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 Otolaryngology Head And Neck Surgeyr Assoc. PA
Address	801 6th St S
City	St Petersburg
State	FL
ZIP	33701
Taxonomy	Specialist
NPI Enumerated	August 22, 2006

Payer Source	Total Paid
Medicaid	$11.2M
Medicare	$0

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

30 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	20,390	$110	$2.3M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	12,360	$150	$1.9M
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…	23,240	$60	$1.3M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	6,810	$180	$1.2M
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…	11,390	$90	$968.5K
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…	9,480	$80	$796K
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	7,170	$110	$760.2K
92579	The provider performs a battery of tests to evaluate hearing loss in infants and toddlers. He uses sound sources to evaluate the auditory response, with reinforcement by animated toys.	18,310	$20	$421.2K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	1,920	$150	$284.6K
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,…	4,490	$60	$278.3K

Showing 1–10 of 30

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Florida Distribution

Pediatric Otolaryngology Head And Neck Surgeyr Assoc. PA — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Florida

Full comparison — all codes billed, vs. Florida median

30 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	1	60	100	$710	$379K
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	1	40	120	$610	$357.5K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	1	80	230	$400	$331.4K
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…	221	5,930	460	$40	$169.3K
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	5	50	270	$160	$141.9K
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…	267	6,380	430	$50	$139.3K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	25	220	150	$160	$117.4K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	20	150	150	$110	$107.6K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	1,374	1,500	470	$30	$87.2K
30140	This CPT code is for a submucous resection of the inferior turbinate (partial or complete by any method).	3	10	80	$990	$85.9K

Showing 1–10 of 30

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Johns Hopkins All Children's Hospital, Inc	FL	Children's Hospital	$0	$152.9M
Pediatric Physician Services, Inc.	FL	Pediatrics Physician	$0	$43.4M
West Coast Neonatology, Inc.	FL	Neonatal-Perinatal Medicine Physician	$0	$18.8M
Access Home Health Care Inc	FL	Home Health Agency	$0	$15.1M
Pediatric Gastroenterology Hepatology & Nutrition Of Fl P A	FL	Pediatric Gastroenterology Physician	$0	$14.9M
Rai Care Centers Of St. Petersburg, LLC	FL	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$11.3M
Ohi West, Inc	FL	Rehabilitation Hospital Unit	$0	$10.3M
St Petersburg Kidney Care LLC	FL	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$9.9M
Fresenius Kidney Care American Dialysis, LLC	FL	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$8.5M
Children's Orthopaedic & Scoliosis Surgery Associates, LLP	FL	Pediatric Orthopaedic Surgery Physician	$0	$7.3M

Pediatric Otolaryngology Head And Neck Surgeyr Assoc. PA — Billing Profile & Reimbursement Data

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Pediatric Otolaryngology Head And Neck Surgeyr Assoc. 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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