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

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

Edward A. Alquero, M.d., Inc. (NPI 1710168265)

Edward A. Alquero, M.d., Inc. is a family medicine physician provider located in Waipahu, Hawaii. This profile covers 0 Medicare and 38 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	Edward A. Alquero, M.d., Inc.
Address	94-141 Pupupuhi St
City	Waipahu
State	HI
ZIP	96797
Taxonomy	Family Medicine Physician
NPI Enumerated	November 26, 2007

Payer Source	Total Paid
Medicaid	$257.1K
Medicare	$0

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

38 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	7,970	$20	$167.3K
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…	5,610	$10	$78.5K
95943	N/A	40	$50	$2K
95923	In this procedure, the provider tests the sudomotor function of the autonomic nervous system to check functioning of nerves that supply sweat glands. The autonomic nervous system is that part of the…	40	$50	$2K
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	560	$1	$1.7K
90674	This code represents a flu vaccine product that protects against four strains of influenza. It is derived from cell cultures, contains no preservatives or antibiotics, and is administered as a 0.5 mL…	90	$20	$1.4K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	200	$10	$1.4K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	250	$1	$1000
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	370	$1	$730
90662	This code represents a flu vaccine product that is a split virus type, contains no preservatives, and has enhanced effectiveness due to a higher antigen content. It is administered as an injection…	90	$10	$600

Showing 1–10 of 38

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Edward A. Alquero, M.d., Inc. — 1 of 14 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

38 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	83	710	650	$90	$274.1K
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…	45	690	650	$90	$235.4K
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	28	70	230	$10	$66.5K
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…	156	170	70	$90	$23.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	85	230	140	$20	$16.1K
36416	In this procedure, the provider pricks the patient’s finger, heel, or ear with a pointed instrument and collects specimen of droplets of blood by pressing the pricking site.	8	10	550	$1	$4.7K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	66	180	120	$10	$4.7K
95943	N/A	3	10	30	$30	$2.8K
95923	In this procedure, the provider tests the sudomotor function of the autonomic nervous system to check functioning of nerves that supply sweat glands. The autonomic nervous system is that part of the…	6	10	90	$30	$2.6K
99072	The provider uses items, supplies materials, or requires clinical staff time in excess of what is normally used or provided for an office visit or other nonfacility encounter. These additional items…	84	90	240	$1	$2.5K

Showing 1–10 of 38

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Preferred Home & Community Based Services, Inc.	HI	Developmentally Disabled Services Day Training Agency	$0	$66.9M
Bayada Home Care	HI	Developmentally Disabled Services Day Training Agency	$0	$33.3M
Hawaii Health Services, Inc.	HI	Home Health Agency	$0	$29.4M
Liberty Dialysis - Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$19.4M
Dsi Waipahu, LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$7.7M
Blue Water Resources	HI	Case Management Agency	$0	$5.7M
Family Services Of Oahu,llc	HI	Developmentally Disabled Services Day Training Agency	$0	$4.9M
Loving Care Health Provider, Inc.	HI	In Home Supportive Care Agency	$0	$4.2M
Leeward Pedodontix, LLC	HI	Pediatric Dentistry	$0	$4.1M
Metropacific Group, Corp	HI	In Home Supportive Care Agency	$0	$2.8M

Edward A. Alquero, M.d., Inc. — 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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