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

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

Connecticut Pediatric Otolaryngology (NPI 1750402038)

Connecticut Pediatric Otolaryngology is a specialist provider located in Madison, Connecticut. This profile covers 0 Medicare and 17 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	Connecticut Pediatric Otolaryngology
Address	230 Boston Post Rd
City	Madison
State	CT
ZIP	06443
Taxonomy	Specialist
NPI Enumerated	April 3, 2007

Payer Source	Total Paid
Medicaid	$3.4M
Medicare	$0

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

17 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…	32,220	$40	$1.4M
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…	9,360	$70	$626.8K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	2,110	$130	$266.4K
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…	2,510	$100	$246.4K
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…	3,420	$60	$219.1K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	2,360	$90	$212.1K
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.	2,010	$90	$171.2K
69210	The provider uses an instrument such as a curette, vacuum evacuation, or forceps to remove entrapped wax from a patient's external auditory canal.	6,070	$20	$133.6K
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…	1,130	$90	$100.7K
69200	The provider removes a foreign body from the external auditory canal without the use of general anesthesia.	980	$60	$60K

Showing 1–10 of 17

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Connecticut Pediatric Otolaryngology — 4 of 17 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

17 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.	3	10	760	$3,080	$4.4M
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	3	10	240	$2,190	$1M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	3	10	270	$510	$521.4K
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…	384	1,590	740	$50	$331.8K
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…	67	1,710	750	$30	$243.3K
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…	5	70	320	$110	$129K
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…	440	480	200	$60	$112.1K
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.	6	20	560	$80	$107.7K
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…	79	480	150	$90	$100.9K
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…	3	70	100	$70	$89.4K

Showing 1–10 of 17

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Waterstone Counseling Center, LLC	CT	Family Medicine Physician	$0	$4.4M
Recovery Services Of Connecticut, LLC	CT	Community/Behavioral Health Agency	$0	$1.2M
Dayna Leigh Giordano Arici, Aprn, Fnp C LLC	CT	Family Nurse Practitioner	$0	$1.1M
Madison Ambulance Association Inc	CT	Land Ambulance	$241.6K	$328.8K
Stephen Zivin	CT	Diagnostic Radiology Physician	$171.8K	$120.9K
Jeremy Moss	CT	Dermatology Physician	$254.6K	$0
Serle Epstein	CT	Internal Medicine Physician	$203.7K	$0
Connecticut Cvs Pharmacy, L.L.C.	CT	Pharmacy	$141K	$0
Keith Mirante	CT	Chiropractor	$40.5K	$74.6K
Elin Christensen	CT	Internal Medicine Physician	$97.1K	$0

Connecticut Pediatric Otolaryngology — Billing Profile & Reimbursement Data

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Connecticut Pediatric Otolaryngology — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References