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

Why is the Medicaid comparison limited to New Jersey 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. New Jersey (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.

Rainbow Pediatrics PC (NPI 1871643957)

Rainbow Pediatrics PC is a pediatrics physician provider located in Cape May Court House, New Jersey. This profile covers 0 Medicare and 46 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	Rainbow Pediatrics PC
Address	2041 N Route 9
City	Cape May Court House
State	NJ
ZIP	08210
Taxonomy	Pediatrics Physician
NPI Enumerated	January 11, 2007

Payer Source	Total Paid
Medicaid	$9.3M
Medicare	$0

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

46 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…	37,530	$70	$2.4M
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…	22,130	$100	$2.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7,410	$110	$778.2K
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…	7,210	$110	$764.6K
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…	8,170	$90	$743K
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,…	8,370	$50	$385.2K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3,150	$120	$362.4K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	2,290	$140	$327.8K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	16,210	$20	$308K
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.	13,200	$20	$303.5K

Showing 1–10 of 46

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Jersey Distribution

Rainbow Pediatrics PC — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Jersey

Full comparison — all codes billed, vs. New Jersey median

46 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…	117	4,450	740	$40	$229.8K
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…	87	3,790	580	$60	$204K
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…	26	550	500	$60	$105.5K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	67	740	150	$100	$100.3K
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…	21	450	470	$60	$97K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	21	590	410	$60	$88.3K
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.	48	680	900	$20	$82.5K
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,…	58	1,520	260	$40	$71.9K
83655	The lab analyst performs a test to measure the amount of lead in the patient specimen. A typical aim of the test is to check for lead exposure.	127	170	170	$10	$71K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	43	530	310	$70	$65.5K

Showing 1–10 of 46

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Arc Of Cape May County	NJ	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$53.8M
Cooper University Hospital Cape Regional Inc	NJ	General Acute Care Hospital	$0	$39.6M
Ars Of Rio Grande, LLC	NJ	Methadone Clinic	$139.7K	$8.4M
Atlanticare Surgery Center Cape May - L.L.C.	NJ	Ambulatory Surgical Clinic/Center	$779K	$0
Ankur Shah	NJ	Diagnostic Radiology Physician	$502.1K	$0
Subhash Mehta	NJ	Internal Medicine Physician	$449.5K	$350
Danielle Ponzio	NJ	Orthopaedic Surgery Physician	$418.5K	$0
Cape Cataract Center, PC	NJ	Ambulatory Surgical Clinic/Center	$412.2K	$0
Domenic Pastore	NJ	Specialist	$412.1K	$0
Louis Capecci	NJ	Diagnostic Radiology Physician	$404.1K	$0

Rainbow Pediatrics PC — Billing Profile & Reimbursement Data

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Rainbow Pediatrics PC — 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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