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.

Orthopedic & Fracture Clinic PA (NPI 1184739351)

Orthopedic & Fracture Clinic PA is a specialist provider located in Caldwell, Idaho. This profile covers 0 Medicare and 10 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	Orthopedic & Fracture Clinic PA
Address	1906 Fairview Ave Ste 400
City	Caldwell
State	ID
ZIP	83605
Taxonomy	Specialist
NPI Enumerated	August 20, 2006

Payer Source	Total Paid
Medicaid	$375.9K
Medicare	$0

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

10 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…	4,730	$50	$227K
99204	The provider sees a new 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 provider…	590	$120	$71.8K
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…	730	$80	$56.9K
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…	180	$80	$14.7K
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,…	90	$30	$2.7K
20610	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	70	$20	$1.4K
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…	10	$70	$910
73562	In this procedure, the provider takes three X–ray images of a patient’s knee joint to check for any fracture, swelling, or reason for pain in the knee area.	20	$20	$370
J1030	Injection, methylprednisolone acetate, 40 mg	30	$10	$130
J3301	Injection, triamcinolone acetonide, not otherwise specified, 10 mg	10	$10	$80

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

Orthopedic & Fracture Clinic PA — 0 of 10 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

10 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…	117	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…	433	620	560	$60	$191.8K
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…	41	220	90	$80	$51.4K
99204	The provider sees a new 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 provider…	25	180	70	$110	$45.6K
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…	70	80	60	$50	$15.1K
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,…	108	210	90	$20	$10.4K
73562	In this procedure, the provider takes three X–ray images of a patient’s knee joint to check for any fracture, swelling, or reason for pain in the knee area.	21	20	310	$10	$3.9K
20610	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	9	20	80	$10	$2.8K
J3301	Injection, triamcinolone acetonide, not otherwise specified, 10 mg	18	20	30	$10	$1.8K
J1030	Injection, methylprednisolone acetate, 40 mg	8	10	50	$1	$1.5K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Michael Daines	ID	Orthopaedic Surgery Physician	$140.4K	$0
George Nicola	ID	Orthopaedic Surgery Physician	$110.6K	$0
John Smith	ID	Orthopaedic Surgery Physician	$90.8K	$0
Craig Jamison	ID	Orthopaedic Surgery Physician	$40.1K	$0
Todd Otstot	ID	Medical Physician Assistant	$33K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saint Alphonsus Regional Medical Center Inc	ID	Family Medicine Physician	$0	$32.6M
Saint Alphonsus Regional Medical Center Inc	ID	Rural Health Clinic/Center	$0	$9.9M
Human Supports Of Idaho	ID	General Practice Physician	$0	$9.4M
County Of Canyon Canyon Co School Dist 132	ID	Local Education Agency (LEA)	$0	$8.3M
West Valley Medical Center, Inc.	ID	General Acute Care Hospital	$0	$7.8M
Carepoint Health Emergency Medicine Idaho, PLLC	ID	Emergency Medicine Physician	$0	$4.3M
Mana Resources LLC	ID	Community/Behavioral Health Agency	$0	$3.1M
Family Eyecare Specialists PLLC	ID	Optometrist	$0	$2.9M
Hope House, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$2.4M
West Valley Medical Group LLC	ID	Internal Medicine Physician	$0	$2.1M

Orthopedic & Fracture Clinic PA — Billing Profile & Reimbursement Data

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Orthopedic & Fracture Clinic PA — 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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