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

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

Shc Medical Center Toppenish (NPI 1013492784)

Shc Medical Center Toppenish is a rural health clinic/center provider located in Union Gap, Washington. This profile covers 0 Medicare and 29 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	Shc Medical Center Toppenish
Address	1420 Ahtanum Ridge Dr
City	Union Gap
State	WA
ZIP	98903
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	September 28, 2018

Payer Source	Total Paid
Medicaid	$5M
Medicare	$0

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

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	43,800	$60	$2.8M
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…	23,560	$50	$1.1M
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…	15,390	$60	$877.3K
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…	850	$80	$68.1K
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…	870	$60	$50.3K
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…	550	$70	$39.2K
99205	The provider sees a new 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 provider…	140	$110	$15.3K
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…	160	$70	$10.5K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	1,460	$10	$10.2K
11721	The provider surgically debrides (debulks or removes) 6 or more abnormal, diseased, or infected nails.	160	$50	$8.8K

Showing 1–10 of 29

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Washington Distribution

Shc Medical Center Toppenish — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

29 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	73	650	4,110	$250	$4.9M
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…	123	1,820	480	$60	$379.6K
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…	120	1,860	610	$40	$295.5K
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…	191	280	540	$70	$166.5K
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…	263	300	400	$80	$164.4K
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…	115	540	130	$90	$128.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	290	320	290	$70	$104.8K
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…	129	560	140	$70	$88.9K
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…	113	530	80	$90	$87.4K
76536	The provider performs real–time ultrasound examination of the soft tissues of the head and neck and records and saves the images for later review.	62	70	310	$80	$55.5K

Showing 1–10 of 29

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sunnyside Community Hospital Association	WA	Critical Access Hospital	$0	$55.1M
Shc Medical Center Toppenish	WA	General Acute Care Hospital	$0	$15.1M
Sunnyside Community Hospital Association	WA	Rural Health Clinic/Center	$0	$7M
Shc Medical Center - Yakima	WA	General Acute Care Hospital	$0	$6.9M
Sunnyside Community Hospital Association	WA	Rural Health Clinic/Center	$0	$5.8M
Sunnyside Community Hospital Association	WA	Rural Health Clinic/Center	$0	$2.8M
Danko Martincic	ID	Hematology & Oncology Physician	$2.6M	$0
Belmond Community Hospital	IA	Rural Health Clinic/Center	$0	$1.9M
Michael Schekall	MN	Diagnostic Radiology Physician	$1.7M	$710
Tatiana Antoci	RI	Family Medicine Physician	$95.7K	$349.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Yakima Valley Farm Workers Clinic	WA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$15.2M
Derek Thompson Dmd Patrick Ferguson Dds	WA	Dentist	$0	$9.4M
Advanced Life Systems, Inc.	WA	Land Ambulance	$1.3M	$5.1M
Renal Treatment Centers West Inc	WA	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3.7M
Oscar Bailon	WA	Cardiovascular Disease Physician	$143.3K	$0
Vu Le	WA	Gastroenterology Physician	$74K	$0

Shc Medical Center Toppenish — Billing Profile & Reimbursement Data

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Shc Medical Center Toppenish — 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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