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

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

Riverside Pediatrics, Inc (NPI 1790742971)

Riverside Pediatrics, Inc is a primary care clinic/center provider located in Sedalia, Missouri. 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	Riverside Pediatrics, Inc
Address	2873 S Ingram Ave
City	Sedalia
State	MO
ZIP	65301
Taxonomy	Primary Care Clinic/Center
NPI Enumerated	April 30, 2006

Payer Source	Total Paid
Medicaid	$4M
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
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…	27,960	$70	$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…	4,750	$90	$446K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4,140	$100	$393K
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…	3,340	$90	$304K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,670	$100	$253.4K
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,…	4,720	$40	$193.6K
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,…	3,240	$40	$119.8K
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…	1,120	$90	$103.1K
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.	6,040	$20	$90.6K
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.	3,560	$20	$53.4K

Showing 1–10 of 38

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

Riverside Pediatrics, Inc — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

38 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	108	320	980	$40	$352.7K
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…	670	3,170	230	$70	$128.1K
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…	55	4,310	300	$60	$110.8K
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…	30	680	280	$90	$65.3K
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…	13	640	210	$90	$59.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	10	600	110	$90	$40.2K
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…	189	860	60	$70	$33.9K
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,…	30	1,020	100	$40	$27K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	9	510	50	$90	$23.9K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	90	350	240	$10	$23.2K

Showing 1–10 of 38

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Therapy Center Of Pettis County, Inc	MO	Developmentally Disabled Services Day Training Agency	$0	$51.3M
Children's Therapy Center Of Pettis County, Inc	MO	Case Management Agency	$0	$33.7M
Bothwell Regional Health Center	MO	General Acute Care Hospital	$0	$19.8M
Pettis County Board Of Services For The Developmentally Disabled	MO	Case Management Agency	$0	$13.7M
Helping All People Pursue Independence (happi), Inc.	MO	Case Manager/Care Coordinator	$0	$10.6M
Shawn Cairer	MO	Developmentally Disabled Services Day Training Agency	$0	$8.4M
Pettis County Ambulance District	MO	Land Ambulance	$845.9K	$5.7M
Regional Health Care Clinic Inc	MO	Federally Qualified Health Center (FQHC)	$0	$5.9M
Children's Therapy Center Of Pettis County, Inc	MO	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$4.9M
Bothwell Regional Health Center	MO	General Practice Physician	$0	$4.9M

Riverside Pediatrics, 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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