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

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

The Pediatric Place (NPI 1801350590)

The Pediatric Place is a pediatrics physician provider located in Rexburg, Idaho. 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	The Pediatric Place
Address	1236 Bond Ave Ste B
City	Rexburg
State	ID
ZIP	83440
Taxonomy	Pediatrics Physician
NPI Enumerated	January 26, 2019

Payer Source	Total Paid
Medicaid	$843.4K
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
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…	2,650	$80	$219.6K
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…	3,480	$60	$212.5K
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…	1,710	$90	$160.8K
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.	2,340	$50	$124.2K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	1,790	$40	$70K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	1,040	$20	$19.8K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	380	$30	$10.2K
99382	The provider performs a well–patient visit for a child who is between the ages of 1 and 4 who meets the definition of new patient.	50	$120	$5.7K
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…	60	$100	$5.4K
99188	The provider applies a fluoride adhesive over the tooth surface to prevent tooth decay, provide remineralization, or treat hypersensitivity.	290	$10	$3.7K

Showing 1–10 of 30

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

The Pediatric Place — 0 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

30 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…	159	670	740	$40	$193.6K
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…	603	620	560	$60	$191.8K
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…	24	80	450	$80	$171.3K
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…	19	80	380	$70	$151.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	58	80	130	$80	$91.4K
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.	17	80	460	$30	$77.7K
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…	134	220	90	$80	$51.4K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	15	60	290	$30	$48.7K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	33	70	240	$20	$34.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	41	180	140	$10	$28.4K

Showing 1–10 of 30

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
County Of Madison School District 321	ID	Local Education Agency (LEA)	$0	$17.1M
Valley Help At Home Senior Care LLC	ID	In Home Supportive Care Agency	$0	$7.9M
Upper Valley Community Health Services Inc	ID	Federally Qualified Health Center (FQHC)	$0	$7.6M
Mhd Therapies, PLLC	ID	Physical Therapist	$0	$7.4M
Upper Valley Options, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$3.7M
Madison Co Memorial Hospital	ID	Obstetrics & Gynecology Physician	$0	$2.6M
Teton Medical Group PLLC	ID	Family Medicine Physician	$0	$2.1M
Clubhouse Pediatric Dentistry Of Madison	ID	Pediatric Dentistry	$0	$1.9M
Seasons Medical, PLLC	ID	Obstetrics & Gynecology Physician	$0	$1.8M
Fall River Medical, PLLC	ID	Primary Care Clinic/Center	$0	$1.7M

The Pediatric Place — Billing Profile & Reimbursement Data

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The Pediatric Place — 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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