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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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 Institute PC (NPI 1245263326)

Orthopedic Institute PC is a multi-specialty clinic/center provider located in Tea, South Dakota. This profile covers 0 Medicare and 24 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 Institute PC
Address	2120 Live Stronger St
City	Tea
State	SD
ZIP	57064
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	July 9, 2006

Payer Source	Total Paid
Medicaid	$567.1K
Medicare	$0

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

24 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…	4,400	$30	$127.7K
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…	2,510	$50	$113K
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…	5,950	$20	$89.2K
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…	2,180	$40	$84.9K
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…	1,980	$20	$45.5K
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,…	1,970	$20	$35.4K
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…	200	$80	$16.3K
20553	Trigger point injection, or TPI, is a medical procedure in which the provider injects an anesthetic or corticosteroid substance into three or more muscles to relieve painful areas or knots in muscles…	550	$20	$13.2K
72110	In this diagnostic procedure, the provider performs at least four X–ray views of the lumbosacral spine to evaluate the patient's spine for the presence of abnormal curves, fractures, or cancer.	450	$20	$9K
73564	In this procedure, the provider takes four or more X–ray views of the knee joint to check for any fracture, swelling, or reason for pain in the knee area.	500	$20	$8K

Showing 1–10 of 24

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Orthopedic Institute PC — 2 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

24 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…	78	340	1,010	$100	$511K
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…	76	260	860	$80	$222.6K
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,…	21	160	210	$120	$97.4K
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…	10	60	640	$20	$72K
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…	13	100	160	$60	$64.4K
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…	34	80	120	$80	$61.5K
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	31	50	380	$30	$52K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	25	40	410	$10	$24.2K
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…	3	20	80	$30	$15.9K
J3301	Injection, triamcinolone acetonide, not otherwise specified, 10 mg	4	20	140	$30	$15.3K

Showing 1–10 of 24

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Michael Adler	SD	Orthopaedic Surgery Physician	$407.3K	$0
David Jones	SD	Orthopaedic Hand Surgery Physician	$323.9K	$0
Richard Curd	SD	Orthopaedic Hand Surgery Physician	$289.9K	$0
Matthew Mckenzie	SD	Orthopaedic Surgery Physician	$275.6K	$0
Corey Rothrock	SD	Adult Reconstructive Orthopaedic Surgery Physician	$273.3K	$0
Timothy Walker	SD	Orthopaedic Surgery Physician	$261.3K	$0
Jason Hurd	SD	Orthopaedic Surgery Physician	$214.6K	$0
Keith Baumgarten	SD	Orthopaedic Surgery Physician	$210K	$0
James Brunz	SD	Pain Medicine (Anesthesiology) Physician	$202.3K	$0
Matthew Wingate	SD	Orthopaedic Surgery of the Spine Physician	$176K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kwang Chang	SD	Physical Medicine & Rehabilitation Physician	$175.5K	$0
Erik Peterson	SD	Orthopaedic Surgery Physician	$139.7K	$0
Gregory Alvine	SD	Orthopaedic Surgery of the Spine Physician	$112.2K	$0
Peter Looby	SD	Orthopaedic Surgery Physician	$81.9K	$0
Evan Hermanson	SD	Orthopaedic Surgery Physician	$81.3K	$0
Luke Rasmussen	SD	Orthopaedic Surgery Physician	$70.7K	$0
Precision Dental Care	SD	General Practice Dentistry	$0	$65.7K
Hunstad Top Gum Dental LLC	SD	General Practice Dentistry	$0	$60.2K
Gregory Neely	SD	Orthopaedic Surgery Physician	$59.3K	$0
Jill Hart	SD	Optometrist	$57.4K	$0

Orthopedic Institute PC — Billing Profile & Reimbursement Data

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Orthopedic Institute PC — 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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