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

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

Madison Co Memorial Hospital (NPI 1073154266)

Madison Co Memorial Hospital is a obstetrics & gynecology physician provider located in Rexburg, Idaho. This profile covers 0 Medicare and 49 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	Madison Co Memorial Hospital
Address	37 S 2nd E
City	Rexburg
State	ID
ZIP	83440
Taxonomy	Obstetrics & Gynecology Physician
NPI Enumerated	September 30, 2019

Payer Source	Total Paid
Medicaid	$2.6M
Medicare	$0

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

49 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…	15,250	$60	$899.9K
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…	5,690	$80	$455K
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…	5,300	$80	$402.4K
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…	3,820	$90	$347.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	8,070	$20	$145.2K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	5,380	$20	$123.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,160	$90	$100.8K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	390	$90	$35.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	260	$100	$25.9K
90474	In this procedure, the provider administers an additional live attenuated vaccine either via oral or intranasal route after the administration of the first vaccine.	1,270	$10	$15.2K

Showing 1–10 of 49

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Madison Co Memorial Hospital — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

49 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…	38	670	740	$40	$193.6K
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…	69	620	560	$60	$191.8K
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…	14	80	450	$80	$171.3K
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…	10	80	380	$70	$151.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	17	80	130	$80	$91.4K
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…	126	140	100	$90	$54.4K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	23	30	290	$60	$52.3K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	16	50	210	$80	$51.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	17	60	50	$70	$35.5K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	9	70	240	$20	$34.3K

Showing 1–10 of 49

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Seasons Medical, PLLC	ID	Obstetrics & Gynecology Physician	$0	$1.8M
Madison Co Memorial Hospital	ID	Family Medicine Physician	$0	$1.6M
Madison Memorial Hospital	ID	Multi-Specialty Clinic/Center	$0	$1.2M
Madison Co Memorial Hospital	ID	General Acute Care Hospital	$0	$721.3K
William Nibley	UT	Medical Oncology Physician	$166K	$326K
Jonathan Hancock	NM	Orthopaedic Surgery Physician	$266.8K	$0
Steven Lofgran	ID	Internal Medicine Physician	$147.4K	$0
Michael Packer	ID	Family Medicine Physician	$112.7K	$0
Brian Beesley	ID	Family Medicine Physician	$90.5K	$0
Douglas Holt	UT	Radiation Oncology Physician	$72.5K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
County Of Madison School District 321	ID	Local Education Agency (LEA)	$0	$17.1M
Valley Help At Home Senior Care LLC	ID	In Home Supportive Care Agency	$0	$7.9M
Upper Valley Community Health Services Inc	ID	Federally Qualified Health Center (FQHC)	$0	$7.6M
Mhd Therapies, PLLC	ID	Physical Therapist	$0	$7.4M
Upper Valley Options, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$3.7M
Teton Medical Group PLLC	ID	Family Medicine Physician	$0	$2.1M
Clubhouse Pediatric Dentistry Of Madison	ID	Pediatric Dentistry	$0	$1.9M
Fall River Medical, PLLC	ID	Primary Care Clinic/Center	$0	$1.7M
Complete Family Care PLLC	ID	Family Medicine Physician	$0	$1.7M
Pmd Therapies, PLLC	ID	Physical Therapist	$0	$1M

Madison Co Memorial Hospital — Billing Profile & Reimbursement Data

Sign up for Madison Co Memorial Hospital — Billing Profile & Reimbursement Data policy alerts

Madison Co Memorial Hospital — Billing Profile & Reimbursement Data

Sign up for Madison Co Memorial Hospital — 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