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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Avera St. Luke's (NPI 1013143296)

Field	Value
Entity Type	Organization
Organization	Avera St. Luke's
Address	105 S State St Ste 113
City	Aberdeen
State	SD
ZIP	57401
Taxonomy	Family Medicine Physician
NPI Enumerated	June 2, 2009

Payer Source	Total Paid
Medicaid	$2.3M
Medicare	$0

Medicaid: Complete Services Breakdown

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

68 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…	23,120	$40	$855.4K
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…	7,980	$50	$423.1K
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…	2,460	$60	$147.7K
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…	2,070	$60	$132.2K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	2,900	$30	$95.7K
W0037	N/A	6,900	$10	$75.9K
0241U	N/A	720	$100	$73.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	940	$60	$59.4K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	3,570	$20	$53.6K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	6,300	$10	$50.4K

Showing 1–10 of 68

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Avera St. Luke's — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

68 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…	14	340	1,010	$100	$511K
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	260	860	$80	$222.6K
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…	12	40	1,100	$80	$181.3K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	22	60	120	$210	$171.2K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	9	30	270	$70	$138.6K
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…	10	50	410	$80	$127.2K
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…	51	70	130	$100	$99K
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,…	97	160	210	$120	$97.4K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	21	110	990	$20	$82.9K
0002A	N/A	16	30	90	$260	$82.8K

Showing 1–10 of 68

Related Providers

Other providers that share a Tax Identification Number (TIN) with Avera St. Luke's, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Avera St Lukes	SD	General Acute Care Hospital	$0	$1.5M
Richard Conklin	SD	Hematology & Oncology Physician	$994.4K	$0
Patrick Parker	GA	Urology Physician	$783.5K	$0
Avera St Luke's	SD	Physical Therapist	$0	$607.7K
Avera St Luke's	SD	Emergency Medicine Physician	$0	$595.8K
Avera St. Luke's	SD	Diagnostic Radiology Physician	$0	$559.6K
Susheel Gundewar	SD	Interventional Cardiology Physician	$448.9K	$0
Avera St. Luke's	SD	Psychiatry Physician	$0	$355.4K
Leslie Lenter	SD	Diagnostic Radiology Physician	$324K	$0
Surgical Associates Endoscopy Clinic LLC	SD	Ambulatory Surgical Clinic/Center	$309.3K	$0

Nearby Providers

Other providers in the same ZIP code as Avera St. Luke's, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Adjustment Training Center, Inc.	SD	Developmentally Disabled Services Day Training Agency	$0	$40.3M
Northeastern Mental Health Center	SD	Mental Health Counselor	$0	$10.1M
Vision Care Associates, LLP	SD	Optometrist	$0	$6M
Sanford Health Network	SD	General Acute Care Hospital	$0	$4.4M
John Bormes	SD	Ophthalmology Physician	$2.6M	$0
Sanford Health Network	SD	General Acute Care Hospital	$0	$1.9M
Avera At Home	SD	Home Health Agency	$0	$1.6M
Ty Hanson	SD	Dermatology Physician	$1.2M	$0
Fettig And Drake Dds PC	SD	General Practice Dentistry	$0	$1M
Isurgery, LLC	SD	Ambulatory Surgical Clinic/Center	$998.3K	$0

Avera St. Luke's — Billing Profile & Reimbursement Data

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Avera St. Luke's — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References