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. Mary's (NPI 1124464128)

Field	Value
Entity Type	Organization
Organization	Avera St. Mary's
Address	801 E Sioux Ave
City	Pierre
State	SD
ZIP	57501
Taxonomy	Medical Specialty Clinic/Center
NPI Enumerated	May 16, 2013

Payer Source	Total Paid
Medicaid	$318.9K
Medicare	$0

Medicaid: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99499	Use 99499 to report evaluation and management services for which there is no specific code available.	960	$180	$172.9K
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…	850	$110	$95.3K
W8710	N/A	140	$230	$31.9K
W8700	N/A	70	$210	$14.1K
99170	The provider examines a child's genitals and anal area with microscopy and possibly image recording for a child suspected of having been sexually abused or assaulted.	50	$90	$4.7K

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. Mary's — 1 of 5 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

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99499	Use 99499 to report evaluation and management services for which there is no specific code available.	2	10	1,680	$210	$359.7K
W8700	N/A	2	10	70	$170	$84.4K
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…	5	20	150	$100	$83.7K
W8710	N/A	1	10	120	$220	$27.7K
99170	The provider examines a child's genitals and anal area with microscopy and possibly image recording for a child suspected of having been sexually abused or assaulted.	2	10	60	$110	$6.8K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Avera Mckennan	SD	Psychiatry Physician	$0	$9.1M
Avera Mckennan	SD	Home Infusion Agency	$0	$6.7M
Avera Mckennan	SD	Air Ambulance	$0	$5.3M
Avera St Marys	SD	Multi-Specialty Clinic/Center	$0	$4.6M
Avera Mckennan	SD	Emergency Medicine Physician	$0	$4.1M
Avera Mckennan	SD	Clinical Medical Laboratory	$307.1K	$2M
Avera St Anthonys Hospital	NE	Rural Health Clinic/Center	$0	$2.3M
Avera Mckennan	SD	Psychiatry Physician	$0	$1.9M
Avera Mckennan	SD	Neonatal-Perinatal Medicine Physician	$0	$1.8M
Avera St Marys	SD	General Acute Care Hospital	$0	$1.7M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Homecare Services Of South Dakota, Inc.	SD	Home Health Agency	$0	$20.1M
Resources For Human Development	SD	Case Management Agency	$0	$8.5M
Capital Area Counseling Service, Inc	SD	Clinical Social Worker	$0	$7.6M
Oahe, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$4.4M
Rising Hope Counseling, LLC	SD	Mental Health Counselor	$0	$4M
Central Dakota Eyecare, LLP	SD	Optometrist	$0	$1.8M
Delta Dental Of South Dakota Foundation	SD	Dental Clinic/Center	$0	$1.2M
Delta Dental Of South Dakota Foundation	SD	Dental Clinic/Center	$0	$1M
Delta Dental Of South Dakota Foundation	SD	Dental Clinic/Center	$0	$594K
American Medical Response Ambulance Service Inc	SD	Ambulance	$310.3K	$261.1K

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

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Avera St. Mary'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