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

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

Edgerton Hospital And Health Services Inc. (NPI 1154350049)

Edgerton Hospital And Health Services Inc. is a critical access hospital provider located in Edgerton, Wisconsin. This profile covers 0 Medicare and 61 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	Edgerton Hospital And Health Services Inc.
Address	11101 N Sherman Rd
City	Edgerton
State	WI
ZIP	53534
Taxonomy	Critical Access Hospital
NPI Enumerated	July 2, 2006

Payer Source	Total Paid
Medicaid	$3.9M
Medicare	$0

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

61 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	3,990	$280	$1.1M
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.	1,350	$430	$580K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	210	$2,550	$526.8K
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.	1,350	$310	$424.8K
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…	1,330	$240	$322.9K
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.	620	$320	$195K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	600	$300	$181.2K
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.	190	$810	$150.2K
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.	430	$280	$118K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	300	$190	$55.6K

Showing 1–10 of 61

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Edgerton Hospital And Health Services Inc. — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

61 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	130	140	3,200	$160	$1.1M
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.	222	360	1,550	$70	$614.4K
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.	239	430	760	$60	$484.6K
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.	114	190	1,790	$90	$390.9K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	17	40	150	$530	$381.9K
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.	166	330	1,350	$60	$338K
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.	140	260	3,590	$20	$232.2K
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…	1,033	1,630	270	$40	$205.3K
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…	527	1,760	250	$40	$173.2K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	177	350	300	$50	$157.9K

Showing 1–10 of 61

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ayman Yaish	WI	Otolaryngology/Facial Plastic Surgery Physician	$264.8K	$0
Mouhammed Rihawi	WI	Pulmonary Disease Physician	$241.9K	$0
Raaid Museitif	WI	Interventional Cardiology Physician	$144.4K	$0
Michael Butterfield	NM	Emergency Medicine Physician	$70.1K	$0
Shailesh Gandhi	GA	Psychiatry Physician	$19.8K	$0
Narendranath Lakshmipathy	ME	Pain Medicine (Anesthesiology) Physician	$13.1K	$0
Aaron Yohann	WI	Physician Assistant	$11.8K	$0
Bradley Wagner	WI	Certified Registered Nurse Anesthetist	$8.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Edgerton Fire Protection District	WI	Land Ambulance	$205K	$24.4K
Amy Millard	WI	Nurse Practitioner	$65.2K	$0
Justin Frey	WI	Family Medicine Physician	$64.2K	$0

Edgerton Hospital And Health Services Inc. — Billing Profile & Reimbursement Data

Sign up for Edgerton Hospital And Health Services Inc. — Billing Profile & Reimbursement Data policy alerts

Edgerton Hospital And Health Services Inc. — Billing Profile & Reimbursement Data

Sign up for Edgerton Hospital And Health Services Inc. — 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