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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

San Juan Regional Medical Center Inc (NPI 1225076003)

San Juan Regional Medical Center Inc is a internal medicine physician provider located in Farmington, New Mexico. This profile covers 0 Medicare and 29 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	San Juan Regional Medical Center Inc
Address	407 S. Schwartz Ave
City	Farmington
State	NM
ZIP	87401
Taxonomy	Internal Medicine Physician
NPI Enumerated	June 3, 2006

Payer Source	Total Paid
Medicaid	$1.5M
Medicare	$0

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

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	13,800	$80	$1.1M
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…	3,490	$50	$185.1K
99215	The provider sees an established 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…	1,780	$100	$173K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	800	$30	$24K
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…	130	$120	$15.2K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	60	$140	$7.8K
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…	40	$160	$7.1K
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	1,000	$10	$7K
99442	N/A	110	$50	$5.7K
94726	The provider performs a pulmonary function test, or PFT, to determine the patient’s lung volumes, such as total lung capacity, residual volume, and functional residual capacity. The testing also may…	530	$10	$4.7K

Showing 1–10 of 29

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

San Juan Regional Medical Center Inc — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

29 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	93	140	130	$220	$568.5K
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…	255	930	910	$80	$521.6K
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…	72	960	1,010	$90	$490K
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,…	341	380	220	$160	$273.9K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	62	90	180	$140	$152.6K
99215	The provider sees an established 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…	45	320	220	$110	$146.2K
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…	261	360	220	$90	$134.7K
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…	199	380	150	$130	$132.8K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	20	60	320	$30	$125.1K
99442	N/A	79	150	140	$90	$71.4K

Showing 1–10 of 29

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
San Juan Regional Medical Center, Inc.	NM	General Acute Care Hospital	$0	$141.5M
San Juan Regional Medical Center Inc	NM	Emergency Medicine Physician	$0	$23.8M
San Juan Regional Medical Center Inc	NM	Pediatrics Physician	$0	$15.7M
San Juan Regional Medical Center Inc	NM	Family Medicine Physician	$0	$7.9M
Orthopedic Associates PA	NM	Orthopaedic Surgery Physician	$0	$4.4M
San Juan Regional Medical Center Inc	NM	Hospitalist Physician	$0	$3.6M
San Juan Regional Medical Center Inc	NM	Neurology Physician	$0	$2.5M
Clayton Labaume	CO	Surgical Physician Assistant	$1.4M	$0
San Juan Regional Medical Center Inc	NM	Psychiatry Physician	$0	$1.4M
Graeme Fisher	IL	Therapeutic Radiology Physician	$658K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Basin Coordinated Healthcare,inc	NM	Personal Care Attendant	$0	$79.7M
Presbyterian Medical Services	NM	Federally Qualified Health Center (FQHC)	$0	$41.2M
Links Ii Inc	NM	In Home Supportive Care Agency	$0	$38.9M
Generations Personal Care, Inc	NM	Personal Care Attendant	$0	$33.9M
Southwestern Private Services, Inc.	NM	Home Health Agency	$0	$30.4M
San Juan Center For Independence	NM	Home Health Agency	$0	$22.5M
Cottonwood Clinical Services, Inc.	NM	Community/Behavioral Health Agency	$0	$18.1M
Better Together Home And Community Services, LLC	NM	Child Intellectual and/or Developmental Disabilities Respite Care	$0	$14.5M
Southwestern Private Services, Inc	NM	Home Health Agency	$0	$7.3M
Pms Dba Roundtree Childrens' Development Services	NM	Developmental Disabilities Clinic/Center	$0	$6.9M

San Juan Regional Medical Center Inc — Billing Profile & Reimbursement Data

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San Juan Regional Medical Center Inc — 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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