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.

Edinburg Pediatric Network LLC (NPI 1669708780)

Edinburg Pediatric Network LLC is a general practice physician provider located in Pharr, Texas. This profile covers 0 Medicare and 108 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	Edinburg Pediatric Network LLC
Address	807 N Cage
City	Pharr
State	TX
ZIP	78577
Taxonomy	General Practice Physician
NPI Enumerated	October 23, 2009

Payer Source	Total Paid
Medicaid	$37.2M
Medicare	$0

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

108 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	323,420	$30	$9.4M
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,…	156,500	$40	$6.3M
S8301	Infection control supplies, not otherwise specified	178,060	$30	$5.2M
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.	246,490	$10	$2.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	25,780	$80	$2M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	21,800	$80	$1.8M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	22,580	$70	$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.	137,040	$10	$1.2M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	105,370	$10	$1.1M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	12,410	$70	$905.6K

Showing 1–10 of 108

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

Edinburg Pediatric Network LLC — 22 of 25 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

108 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	124	160	200	$280	$321.8K
80050	The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the…	44	150	170	$30	$302.9K
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	166	240	420	$30	$296.8K
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…	7	6,040	710	$40	$232.8K
87631	The lab analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus,…	46	140	180	$60	$215.9K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	15	1,500	880	$80	$185.8K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	40	1,360	800	$80	$185.6K
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…	132	5,810	540	$50	$155.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	9	1,540	650	$80	$150.4K
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…	180	350	230	$70	$120.3K

Showing 1–10 of 108

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ace Primary Homecare Inc	TX	Home Health Agency	$0	$91.9M
Epic Health Services, Inc.	TX	Home Health Agency	$0	$62.7M
Guadalupe Home Care Inc	TX	Home Health Agency	$0	$39.3M
San Jose Health Care, LLC	TX	Home Health Agency	$0	$38.7M
All-valley Primary Home Care Inc	TX	Home Health Agency	$0	$27.6M
Canvi Group, LLC	TX	Home Health Agency	$0	$19.9M
Trebar Inc.	TX	Home Health Agency	$0	$19.5M
Liberty Dme, LLC	TX	Durable Medical Equipment & Medical Supplies	$0	$15.3M
Unidos Healthcare, LLC	TX	Home Health Agency	$0	$13.7M
Pharr-san Juan-alamo Isd	TX	Local Education Agency (LEA)	$0	$13.6M

Edinburg Pediatric Network LLC — Billing Profile & Reimbursement Data

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Edinburg Pediatric Network LLC — 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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References