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.

Ascension St Francis Hospital, Inc (NPI 1225087190)

Field	Value
Entity Type	Organization
Organization	Ascension St Francis Hospital, Inc
Address	3237 S 16th St
City	Milwaukee
State	WI
ZIP	53215
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 9, 2006

Payer Source	Total Paid
Medicaid	$35.9M
Medicare	$0

Key Findings

ASCENSION ST FRANCIS HOSPITAL, INC reports no Medicare billing on file and $35.9M in lifetime Medicaid revenue, making its present payer footprint effectively single-payer Medicaid rather than a mixed Medicare/Medicaid provider. This concentration means analyses of utilization and revenue should focus on Medicaid-coded services and state-level comparisons rather than national Medicare benchmarks.

Revenue is highly concentrated in a small number of Medicaid codes: the precomputed top three Medicaid codes account for 41.1% of the provider's total Medicaid revenue. Those top three are 99283 ($4.5M revenue (17.3% of this provider's total Medicaid revenue)), 99284 ($3.1M revenue (12.1% of this provider's total Medicaid revenue)), and 96361 ($3M revenue (11.6% of this provider's total Medicaid revenue)), indicating a reliance on a few high-volume service lines.

The code mix points to a high-volume emergency department operation supported by inpatient/ED ancillary services: 99283 has 73.9K claims, 99284 has 55.2K claims, and 99285 has 27.4K claims, and multiple E/M levels (99281–99285) appear in the top codes. These E/M volumes, together with high counts for labs and imaging (e.g., 80053: 52.8K claims; 70450: 6.3K claims), imply significant ED throughput with routine laboratory and CT imaging support.

Infusion and specialty biologic administration are another distinct service line. High-cost medication billing appears via J2350 (475 claims, $3890 avg paid/claim, $1.8M revenue (7.1% of this provider's total Medicaid revenue)) where the provider ranks #1 of 4 in-state (100th percentile), and J2323 (2.2K claims, $359 avg paid/claim, $786.9K revenue (3.0% of this provider's total Medicaid revenue)) where it also ranks #1 of 3 in-state (100th percentile); this pattern is consistent with a staffed infusion program delivering specialty IV biologics.

Diagnostic and high-throughput infectious disease testing are prominent in the billing mix. The provider reports 87502 (10.6K claims, $1M revenue (4.0% of this provider's total Medicaid revenue)) ranked #5 of 168 in-state (98th percentile; extreme outlier, far above typical state volume for this code), and 87635 (14.9K claims, $699.9K revenue (2.7% of this provider's total Medicaid revenue)) ranked #7 of 261 (98th percentile; notably above typical state volume), indicating above-typical respiratory/viral testing throughput in addition to routine panels like 80053 (52.8K claims, $1.3M revenue).

Multiple top codes are extreme high-percentile outliers in-state, signaling dominant local market presence for certain services. For emergency E/M, 99283 ranks #8 of 362 providers (98th percentile; extreme outlier, far above typical state volume for this code) and 99284 ranks #10 of 432 (98th percentile; notably above typical state volume for this code), while testing code 87502 is an additional extreme outlier; collectively these ranks indicate the provider is a major outlier and high-volume performer in Wisconsin for ED and infectious disease testing.

The provider’s revenue and service mix create a concentrated operational risk profile: with 41.1% of Medicaid revenue coming from the three top codes, reimbursement changes, shifts in ED utilization, or changes in infusion drug mix could materially affect overall Medicaid revenue. Analysts should treat ED E/M volumes and infusion drug billing as primary drivers when modeling revenue sensitivity or negotiating network arrangements.

ASCENSION ST FRANCIS HOSPITAL, INC has an established presence in the NPI registry, enumerated on 2006-05-09 (~20 years ago), which—combined with the high-volume ED, lab, and infusion activity—suggests a longstanding regional acute care hub and built capacity for both emergency services and outpatient infusion/diagnostic workflows.

Medicaid: Complete Services Breakdown

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

340 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.	73,860	$60	$4.5M
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.	55,160	$60	$3.1M
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.	20,430	$150	$3M
J2350	Injection, ocrelizumab, 1 mg	480	$3,890	$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.	27,420	$50	$1.5M
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.	52,830	$30	$1.3M
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…	10,600	$100	$1M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	26,180	$40	$942.6K
J2323	Injection, natalizumab, 1 mg	2,190	$360	$786.9K
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.	11,900	$70	$773.8K

Showing 1–10 of 340

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

Ascension St Francis Hospital, Inc — 11 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

340 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.	9	140	3,200	$160	$1.1M
J2350	Injection, ocrelizumab, 1 mg	1	10	140	$3,710	$705.3K
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.	8	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.	10	430	760	$60	$484.6K
U0004	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by…	11	20	320	$60	$483K
J0585	Injection, onabotulinumtoxina, 1 unit	9	30	550	$240	$428.8K
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.	16	190	1,790	$90	$390.9K
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.	18	140	2,200	$90	$358.4K
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.	16	330	1,350	$60	$338K
J2323	Injection, natalizumab, 1 mg	1	10	80	$380	$291.1K

Showing 1–10 of 340

Nearby Providers

Other providers in the same ZIP code as Ascension St Francis Hospital, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Aurora Health Care Metro, Inc.	WI	General Acute Care Hospital	$0	$181.9M
Aurora Medical Group, Inc.	WI	Certified Registered Nurse Anesthetist	$2.2K	$139.2M
Jeffrey Weber	WI	Gastroenterology Physician	$20.8M	$0
Sixteenth Street Community Health Centers, Inc.	WI	Federally Qualified Health Center (FQHC)	$0	$13.8M
Familia Dental Mkemitchell LLC	WI	Dental Clinic/Center	$0	$8.5M
Ermed, Sc	WI	Emergency Medicine Physician	$0	$8.1M
Midwest Nephrology Associates, S.c.	WI	Nephrology Physician	$0	$5.7M
Bright Dental 1 LLC	WI	General Practice Dentistry	$0	$4.6M
Fresenius Medical Care Midwest Dialysis, LLC	WI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3.9M
Sweet Smiles Milwaukee LLC	WI	General Practice Dentistry	$0	$3.7M

Ascension St Francis Hospital, Inc — Billing Profile & Reimbursement Data

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Ascension St Francis Hospital, Inc — 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

Nearby Providers

Frequently Asked Questions

References