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 1134592017)

Madison Co Memorial Hospital is a family medicine physician provider located in Rexburg, Idaho. This profile covers 0 Medicare and 36 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	393 E 2nd N
City	Rexburg
State	ID
ZIP	83440
Taxonomy	Family Medicine Physician
NPI Enumerated	November 2, 2015

Payer Source	Total Paid
Medicaid	$1.6M
Medicare	$0

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

36 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…	17,180	$60	$1M
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…	2,280	$90	$200.2K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	2,060	$40	$88.6K
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…	870	$100	$88.1K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	2,330	$30	$62.9K
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…	680	$90	$61.1K
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…	180	$80	$14.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	80	$100	$8.1K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	2,350	$1	$7K
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…	440	$10	$5.2K

Showing 1–10 of 36

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 — 1 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

36 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…	32	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…	286	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…	31	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…	20	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.	44	80	130	$80	$91.4K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	18	80	460	$30	$77.7K
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…	27	50	210	$80	$51.4K
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…	191	220	90	$80	$51.4K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	12	60	290	$30	$48.7K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	69	70	2,170	$10	$42.9K

Showing 1–10 of 36

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Madison Co Memorial Hospital	ID	Obstetrics & Gynecology Physician	$0	$2.6M
Seasons Medical, PLLC	ID	Obstetrics & Gynecology Physician	$0	$1.8M
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

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Madison Co Memorial Hospital — 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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