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

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

Providence Health & Services - Wa (NPI 1144471715)

Key Findings

Field	Value
Entity Type	Organization
Organization	Providence Health & Services - Wa
Address	101 W 8th Ave
City	Spokane
State	WA
ZIP	99204
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 1, 2008

Payer Source	Total Paid
Medicaid	$78.7M
Medicare	$0

This provider is effectively a Medicaid-focused hospital: there is no Medicare billing on file while total Medicaid revenue is $78.7M, indicating a single-payer concentration of scale in the available data. Analysts should treat Medicare-level comparisons as not applicable for this entity because Medicare reporting is absent.

Revenue is highly concentrated in a small set of Medicaid services: the top 3 Medicaid codes account for 42.5% of total Medicaid revenue. Those top drivers are 99283 ($10.7M revenue, 17.6%), 96361 ($9.3M revenue, 15.3%), and 99284 ($5.8M revenue, 9.6%), signaling dependence on emergency-department E/M and IV fluid/infusion services for a large share of Medicaid dollars.

Operationally the code mix points to a high-volume emergency department and infusion center: 99283 shows 81.1K claims at $132 avg paid/claim ($10.7M revenue) and 99284 shows 62.2K claims at $94 avg paid/claim ($5.8M revenue), while 99285 also appears with 54.5K claims ($4.3M). These volumes and revenues indicate routine, sustained ED throughput across low, moderate, and high complexity E/M levels.

Infusion and IV fluid administration are a distinctive service-line for this provider: 96361 has 29.5K claims ($316 avg paid/claim, $9.3M revenue) and other infusion codes—96365, 96366, 96360—also contribute materially. Several of these infusion codes are flagged as notably above typical state volume (e.g., 96361 is described as notably above typical state volume), suggesting an operational emphasis or capacity for IV therapy/observation.

Competitively this hospital is a major statewide participant for several Medicaid codes: 99283 ranks #9 of 234 providers in-state (97th percentile; notably above typical state volume for this code), 96365 ranks #6 of 101 providers (95th percentile; notably above typical state volume), and 93306 ranks #9 of 130 (94th percentile). These high percentiles indicate the provider is among the largest in-state deliverers for multiple ED, imaging, and infusion services.

Advanced imaging and cardiology diagnostics are meaningful revenue contributors: 93306 (echocardiography) generates $3.4M and ranks #9 of 130 (94th percentile), CT head 70450 generates $1.9M and ranks #15 of 129 (89th percentile), and abdominal/pelvic CT 74177 contributes $1.7M (rank #25 of 139, 83th percentile). This mix supports a well-developed diagnostic/imaging platform tied closely to emergency and inpatient workflows.

The provider maintains notable market positions in several discrete surgical and specialty services: 44970 (laparoscopic appendectomy) shows 450 claims with $1.5M revenue and ranks #2 of 11 providers in-state (90th percentile), while 67311 (strabismus surgery) is ranked #1 of 5 providers (100th percentile) with $668.5K revenue. These rankings suggest the hospital is a regional referral site for selected surgical procedures despite its ED/infusion revenue concentration.

The provider has been an established NPI registrant since 2008-10-01 (~18 years ago), which, combined with high Medicaid volumes and strong in-state market ranks across emergency, infusion, imaging, and select surgical codes, indicates a long-standing operational footprint and service specialization that payers and competitors should consider when modeling network capacity and referral patterns.

Medicaid: Complete Services Breakdown

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

578 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	81,090	$130	$10.7M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	29,510	$320	$9.3M
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.	62,210	$90	$5.8M
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.	54,550	$80	$4.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	37,560	$100	$3.8M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	13,150	$260	$3.4M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	19,240	$110	$2.1M
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	4,530	$420	$1.9M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	12,810	$150	$1.9M
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…	23,480	$80	$1.9M

Showing 1–10 of 578

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Washington Distribution

Providence Health & Services - Wa — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

578 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	24	100	2,830	$80	$3.8M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	9	110	5,950	$270	$2.6M
S9480	Intensive outpatient psychiatric services, per diem	8	20	3,390	$220	$2M
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.	18	230	5,440	$90	$1.8M
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.	9	230	6,220	$100	$1.8M
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.	14	190	5,130	$100	$1.8M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	25	140	2,830	$150	$1.1M
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…	13	100	1,940	$70	$1M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	17	20	190	$1,670	$956.2K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	25	170	2,120	$40	$779.1K

Showing 1–10 of 578

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services Washington	WA	Pulmonary Disease Physician	$0	$78.6M
Mancong Zhang	WA	Anatomic Pathology & Clinical Pathology Physician	$150.2K	$0
Mill Etienne	NY	Epilepsy Physician	$142K	$0
Thomas Kwiatkowski	MA	Neurology Physician	$112.9K	$3.3K
Truc Pham	WA	Anatomic Pathology & Clinical Pathology Physician	$106.2K	$0
Georgi Pirumyan	WA	Anatomic Pathology & Clinical Pathology Physician	$97.1K	$0
Liqun Yin	WA	Anatomic Pathology & Clinical Pathology Physician	$89.4K	$0
Vibhav Bansal	IN	Vascular Neurology Physician	$86.8K	$0
Sydney Piercey	UT	Neurology Physician	$81.9K	$0
Carolina Valdes	FL	Neurology Physician	$66.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Multicare Health System	WA	General Acute Care Hospital	$0	$55.1M
New Horizon Care Center, Inc.	WA	Substance Abuse Rehabilitation Facility	$0	$20.2M
Spokane Addiction Recovery Centers	WA	Substance Abuse Rehabilitation Facility	$0	$19M
Spokane Emergency Care Physicians PLLC	WA	Emergency Medicine Physician	$0	$13.9M
Spokane Emergency Physicians, Ps	WA	Emergency Medicine Physician	$0	$13.1M
Providence Health & Services Washington	WA	Clinical Medical Laboratory	$1.6M	$9.3M
Spokane Eye Clinic Ps	WA	Multi-Specialty Clinic/Center	$0	$8M
Laboratory Corporation Of America	WA	Clinical Medical Laboratory	$1.6M	$6.1M
Integra Imaging, Ps	WA	Diagnostic Radiology Physician	$0	$7.5M
Shriners Hospitals For Children	WA	Children's Hospital	$0	$6.1M

Providence Health & Services - Wa — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References