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.

Sanford Clinic (NPI 1043583537)

Sanford Clinic is a anatomic pathology & clinical pathology physician provider located in Sioux Falls, South Dakota. This profile covers 0 Medicare and 13 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	Sanford Clinic
Address	1305 W 18th St
City	Sioux Falls
State	SD
ZIP	57105
Taxonomy	Anatomic Pathology & Clinical Pathology Physician
NPI Enumerated	February 15, 2012

Payer Source	Total Paid
Medicaid	$841.4K
Medicare	$0

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	15,480	$40	$588.2K
88307	The physician, typically a pathologist, performs a level V examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	3,460	$40	$152.2K
88342	The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,…	2,680	$20	$40.1K
88304	The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	1,980	$10	$21.8K
85060	The physician, typically a clinical pathologist, performs a peripheral blood smear review and provides an interpretation and written report of the examination.	1,560	$10	$10.9K
88108	The analyst prepares smears of cytopathology fluids, washings, or brushings, except for cervical or vaginal fluid, using a concentration technique and interprets his findings. Cytopathology is the…	1,320	$10	$10.6K
88141	The physician analyzes and interprets a cervical or vaginal cytopathology specimen, using any reporting system, such as Bethesda or non–Bethesda. This code is for the professional interpretation by…	560	$10	$7.3K
88302	The physician, typically a pathologist, performs a level II examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	600	$10	$4.8K
84165	The lab analyst performs the technical lab test to separate and quantitate components of serum protein in a process called serum protein electrophoresis, SPE, or SPEP. The electrophoretic…	530	$1	$2.1K
88341	The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified…	30	$50	$1.5K

Showing 1–10 of 13

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

Sanford Clinic — 6 of 13 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

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	1	20	210	$50	$104.8K
88307	The physician, typically a pathologist, performs a level V examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	1	10	970	$60	$78.7K
88304	The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	2	10	1,190	$20	$21.8K
88342	The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,…	1	10	810	$20	$16.3K
88108	The analyst prepares smears of cytopathology fluids, washings, or brushings, except for cervical or vaginal fluid, using a concentration technique and interprets his findings. Cytopathology is the…	1	10	1,320	$10	$11.2K
88141	The physician analyzes and interprets a cervical or vaginal cytopathology specimen, using any reporting system, such as Bethesda or non–Bethesda. This code is for the professional interpretation by…	2	10	530	$10	$9.8K
85060	The physician, typically a clinical pathologist, performs a peripheral blood smear review and provides an interpretation and written report of the examination.	1	10	460	$10	$5.8K
88302	The physician, typically a pathologist, performs a level II examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	1	10	360	$10	$3.8K
88341	The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified…	3	10	50	$60	$3.7K
88311	The lab analyst performs a decalcification procedure on a specimen. Dissolving the calcium makes it easier to perform certain examinations.	4	10	230	$10	$1.9K

Showing 1–10 of 13

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Sanford Medical Center	SD	General Acute Care Hospital	$0	$24.4M
Sanford Clinic	SD	Diagnostic Radiology Physician	$0	$6M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M
Sanford Clinic	SD	Hospitalist Physician	$0	$2.9M
Sanford Clinic	SD	Family Medicine Physician	$0	$2M
Sanford Clinic	SD	Maternal & Fetal Medicine Physician	$0	$1.2M
Sanford Clinic	SD	Obstetrics & Gynecology Physician	$0	$1.2M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Dakota Achieve	SD	Developmental Disabilities Clinic/Center	$0	$166.9M
Dakotabilities	SD	Voluntary or Charitable Agency	$0	$77.8M
Volunteers Of America, Dakotas	SD	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$60.9M
Southeastern Behavioral Healthcare	SD	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$59.1M
Resouces For Human Development, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$31.1M
Childrens Dental Center	SD	Pediatric Dentistry	$0	$24M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Avera Mckennan	SD	Air Ambulance	$0	$5.3M
Avera Mckennan	SD	Emergency Medicine Physician	$0	$4.1M

Sanford Clinic — Billing Profile & Reimbursement Data

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Sanford Clinic — 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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