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

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

Wilcox Memorial Hospital (NPI 1225113442)

Field	Value
Entity Type	Organization
Organization	Wilcox Memorial Hospital
Address	3-3420 Kuhio Hwy
City	Lihue
State	HI
ZIP	96766
Taxonomy	Rural Acute Care Hospital
NPI Enumerated	October 26, 2006

Payer Source	Total Paid
Medicaid	$28M
Medicare	$0

Key Findings

WILCOX MEMORIAL HOSPITAL is effectively a single-payer Medicaid provider in the available data: there is no Medicare billing on file while total Medicaid revenue is reported as $28M. This concentration means the provider’s reported financial footprint in these datasets is driven exclusively by Medicaid activity rather than a mixed Medicare/Medicaid payer mix.

Revenue is highly concentrated in emergency department evaluation-and-management codes: the top three Medicaid codes (99283, 99284, 99285) together account for 69.3% of the provider’s total Medicaid revenue. Individually those codes are reported as 99283: $7.3M revenue (26.8%), 99284: $6.2M revenue (22.7%), and 99285: $5.4M revenue (19.8%), indicating that ED visits are the primary revenue drivers.

The operational mix implied by the code set is an ED-and-observation focused rural acute care hospital. High revenue and claim counts for ED E/M codes are accompanied by observation-hours G0378 ($1.8M, 6.8%) and abdominal/pelvic CT 74177 ($1.7M, 6.2%), which together suggest frequent ED-to-observation workflows and on‑site diagnostic imaging capacity supporting acute care.

Claim volumes for the top ED codes are large in absolute counts, consistent with sustained ED throughput: 99283 shows 15.9K claims at $461 avg paid/claim, 99284 shows 12.2K claims at $509 avg paid/claim, and 99285 shows 7.6K claims at $713 avg paid/claim. These claim-level figures reinforce that patient visits — not a few high-dollar procedures — are driving Medicaid revenue.

State competitive standing for core ED codes is modest rather than dominant. The provider ranks #16 of 45 for 99283 (66th percentile, described as typical/unremarkable), #18 of 47 for 99284 (63rd percentile, typical/unremarkable), and #13 of 39 for 99285 (68th percentile, typical/unremarkable), indicating it is a routine state-level participant in emergency care volumes rather than an outlier leader.

Imaging and musculoskeletal diagnostics show pockets of above-typical statewide volume that complement the ED workload: 73564 (knee x‑rays) is ranked #1 of 16 (100th percentile, notably above typical), 73110 (wrist x‑rays) is #2 of 26 (96th percentile, notably above typical), and 73130 (hand x‑rays) is #3 of 25 (92nd percentile, notably above typical). These outsized radiography ranks suggest higher local demand for orthopedic/imaging services tied to acute injury care.

Rehabilitation and other ancillary services are also present at meaningful volume relative to peers: 97110 (therapeutic exercise) has 8.5K claims, $33 avg paid/claim and $279.7K revenue (1.0%), ranking #13 of 110 (89th percentile), while 97140 (manual therapy) reports 6.6K claims, $23 avg paid/claim and $151.9K revenue (0.6%), ranking #7 of 88 (93rd percentile). These placements indicate a robust in-house physical therapy footprint that supports post-acute and outpatient recovery needs.

The provider’s NPI was enumerated on 2006-10-26 (~20 years ago), establishing it as a long-tenured rural acute care hospital in its market. Combined with the lack of Medicare billing on file and the heavy Medicaid/ED revenue concentration, the profile suggests operational dependence on Medicaid-funded emergency and imaging services — a payer-concentration exposure to monitor for payer policy or enrollment shifts.

Medicaid: Complete Services Breakdown

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

191 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.	15,850	$460	$7.3M
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.	12,150	$510	$6.2M
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.	7,580	$710	$5.4M
G0378	Hospital observation service, per hour	3,720	$500	$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.	2,610	$640	$1.7M
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.	4,050	$360	$1.5M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	1,430	$530	$756.8K
L8699	Prosthetic implant, not otherwise specified	460	$880	$405.3K
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…	1,870	$190	$359.9K
77067	The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software…	3,490	$100	$356K

Showing 1–10 of 191

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Wilcox Memorial Hospital — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

191 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	16	50	8,590	$340	$5.2M
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	50	3,740	$290	$3.8M
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.	13	40	3,820	$330	$3.3M
G0378	Hospital observation service, per hour	5	10	3,250	$480	$2.3M
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.	13	30	2,660	$330	$1.5M
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.	13	40	1,050	$510	$1.3M
J3490	Unclassified drugs	5	50	160	$200	$740.3K
99281	The provider sees a patient for the lowest level emergency department visit.	12	20	950	$220	$651.2K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	15	20	1,060	$60	$547.3K
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	9	30	770	$430	$536.6K

Showing 1–10 of 191

Nearby Providers

Other providers in the same ZIP code as Wilcox Memorial Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kauai Medical Clinic	HI	Multi-Specialty Clinic/Center	$0	$5M
Liberty Dialysis - Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$4.7M
Bayada Home Care	HI	In Home Supportive Care Agency	$0	$3.5M
Karin Stoll	HI	Mental Health Counselor	$52.7K	$1.2M
Kuhio Pediatric Dental LLC	HI	General Practice Dentistry	$0	$925.9K
Hawaiian Island Dental, Inc.	HI	General Practice Dentistry	$0	$875.6K
Hawaii Life Flight, LLC	HI	Air Ambulance	$458.5K	$370K
Toothbuds Kauai, LLC	HI	Dentist	$0	$803.9K
Stephanie Skow Md Inc	HI	Psychiatry Physician	$0	$545.8K
Mastercare Inc	HI	In Home Supportive Care Agency	$0	$522.7K

Wilcox Memorial Hospital — Billing Profile & Reimbursement Data

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Wilcox Memorial Hospital — 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