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

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

St Joseph Mercy Hospital-smhc (NPI 1053356352)

St Joseph Mercy Hospital-smhc is a general acute care hospital provider located in Pontiac, Michigan. This profile covers 0 Medicare and 444 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	St Joseph Mercy Hospital-smhc
Address	44405 Woodward Ave
City	Pontiac
State	MI
ZIP	48341
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 19, 2006

Payer Source	Total Paid
Medicaid	$51.8M
Medicare	$0

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

444 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	36,590	$260	$9.4M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	19,500	$420	$8.2M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	54,210	$130	$7.2M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	35,820	$90	$3.2M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	30,260	$70	$2.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	24,440	$70	$1.6M
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	31,800	$30	$890.3K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	9,800	$80	$774.4K
76818	The provider performs a biophysical profile test to measure the health of the baby during pregnancy. The test consists of a nonstress test and an ultrasound.	12,460	$60	$747.4K
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	27,420	$30	$740.2K

Showing 1–10 of 444

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

St Joseph Mercy Hospital-smhc — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

444 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	48	150	5,330	$50	$2.8M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	71	400	1,510	$190	$2.6M
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	7	10	160	$180	$2.3M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	55	480	1,350	$110	$1.7M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	29	450	1,540	$90	$1.3M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	16	150	7,610	$90	$1.2M
G0378	Hospital observation service, per hour	17	100	2,820	$180	$1.1M
A4351	Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each	14	10	1,300	$90	$968.7K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	30	30	300	$920	$652.6K
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…	31	160	2,720	$60	$546.6K

Showing 1–10 of 444

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Memorial Hospital	MI	General Practice Physician	$0	$17.3M
Adam Heinrich	FL	Certified Registered Nurse Anesthetist	$38.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Common Ground	MI	Community/Behavioral Health Agency	$0	$44.5M
Oakland Family Services	MI	Clinic/Center	$0	$25.6M
Sjmh Medical Practice-smhc	MI	Internal Medicine Physician	$0	$14.8M
John Antonucci	MI	Radiation Oncology Physician	$786.7K	$0
Michael Ghilezan	MI	Radiation Oncology Physician	$627.8K	$0
Frank Vicini	MI	Radiation Oncology Physician	$609.1K	$0
Dilraj Ghumman	MI	Diagnostic Radiology Physician	$592K	$0
Arezo Amirikia	MI	Ophthalmology Physician	$563.9K	$0
Larry Kestin	MI	Radiation Oncology Physician	$562.3K	$0
Sameer Naik	MI	Student in an Organized Health Care Education/Training Program	$409.7K	$0

St Joseph Mercy Hospital-smhc — Billing Profile & Reimbursement Data

Sign up for St Joseph Mercy Hospital-smhc — Billing Profile & Reimbursement Data policy alerts

St Joseph Mercy Hospital-smhc — Billing Profile & Reimbursement Data

Sign up for St Joseph Mercy Hospital-smhc — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References