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

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

Banner Estrella Medical Center (NPI 1275566200)

Key Findings

Field	Value
Entity Type	Organization
Organization	Banner Estrella Medical Center
Address	9201 W Thomas Rd
City	Phoenix
State	AZ
ZIP	85037
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 10, 2006

Payer Source	Total Paid
Medicaid	$108M
Medicare	$0

BANNER ESTRELLA MEDICAL CENTER reports no Medicare billing on file and $108M in lifetime Medicaid revenue, indicating the facility’s billing footprint in available data is effectively single‑payer Medicaid. The provider’s NPI was enumerated on 2006-07-10 (~20 years ago), so this is a long‑standing hospital operation in the market rather than a recent entrant.

Revenue is highly concentrated: the precomputed top three Medicaid codes (99285, 99284, 74177) together account for 58.9% of the provider’s total Medicaid revenue. That concentration means a majority of Medicaid dollars are driven by a small set of high‑volume ED evaluation-and-management codes and a major CT imaging code.

The code mix points to an emergency‑department and diagnostic imaging–centric operation. 99285 (high‑complexity ED E/M) alone generates $25.2M (25.0% of Medicaid revenue) with 79.6K claims, and 99284 (moderate‑complexity ED E/M) contributes $20.3M (20.1%); combined with 74177 (CT abdomen/pelvis with contrast, $14M, 13.9%) these three codes dominate clinical activity and revenue, implying heavy throughput of acute presentations requiring advanced imaging.

Competitive standing in the state for emergency services is strong: 99285 ranks #11 of 257 providers in‑state (96th percentile; notably above typical state volume for this code) and 99284 ranks #13 of 259 (95th percentile; notably above typical state volume). Other ED levels such as 99283 (rank #18 of 258, 93th percentile) and 99282 (rank #16 of 159, 91th percentile) are also at or above typical state volumes, reinforcing a high regional ED market share.

Imaging and advanced diagnostics are a significant secondary service line. 74177 (CT abdomen/pelvis with contrast) is $14M (13.9% of Medicaid revenue) and ranks #12 of 175 providers in‑state (94th percentile; typical, unremarkable volume for this code), while related CT and CTA codes (e.g., 70450, 71275, 70496) appear among the top services, signaling substantial investment and utilization of CT imaging resources.

The hospital shows outlier surgical activity in specific procedures: 47562 (laparoscopic cholecystectomy) generates $6.2M (6.1% of Medicaid revenue) and ranks #1 of 30 providers in‑state (100th percentile; extreme outlier, far above typical state volume for this code). This suggests BANNER ESTRELLA functions as a regional surgical referral center for certain acute/general surgery cases in addition to its ED role.

Clinical acuity beyond ED visits is present but less dominant: 99291 (critical care) accounts for $2M (2.0% of Medicaid revenue) and ranks #48 of 200 providers in‑state (76th percentile; typical, unremarkable volume), while hospital observation service G0378 appears at $996.7K (1.0%) and ranks #7 of 76 (92th percentile; notably above typical state volume). These codes indicate available critical care and observation capacity that supports the ED and inpatient flow.

From a payer‑risk and operational perspective, the facility’s Medicaid reliance and top‑code concentration (58.9% from three codes) means changes in ED reimbursement, imaging policy, or Medicaid utilization management could materially affect revenue. For network planning and competitive analysis, BANNER ESTRELLA should be treated as a Medicaid‑centered, high‑volume ED and imaging hub with notable surgical specialization in laparoscopic cholecystectomy.

Medicaid: Complete Services Breakdown

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

412 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	79,580	$320	$25.2M
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.	96,360	$210	$20.3M
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.	24,300	$580	$14M
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.	57,200	$180	$10.5M
47562	The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease.	1,840	$3,360	$6.2M
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.	11,350	$360	$4.1M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	22,610	$90	$2.1M
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	2,030	$970	$2M
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.	17,950	$110	$1.9M
71275	In this procedure, the provider performs a computed tomographic angiography, or CTA imaging of the chest to get detailed images of the blood vessels but not the heart. He performs this study using a…	7,370	$260	$1.9M

Showing 1–10 of 412

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Arizona Distribution

Banner Estrella Medical Center — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. Arizona median

412 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	11	260	1,330	$240	$3.5M
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.	13	260	3,030	$190	$3.4M
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.	18	260	2,600	$170	$2.6M
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.	12	180	1,490	$320	$2.2M
44970	Laparoscopy, surgical, appendectomy	7	10	110	$4,670	$2.1M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	21	110	960	$70	$1.7M
47562	The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease.	1	30	70	$3,620	$999.9K
G0378	Hospital observation service, per hour	7	80	6,320	$70	$961.9K
58661	The provider removes one or both ovaries and one or both fallopian tubes or a combination of both using a laparoscope.	4	10	350	$2,840	$935.9K
C1713	Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)	19	50	450	$920	$775.4K

Showing 1–10 of 412

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Therapy Tree, PLLC	AZ	Hearing and Speech Clinic/Center	$0	$54.6M
Desert Valley Pediatrics	AZ	Pediatrics Physician	$0	$21.2M
Pedro Denga	AZ	Contractor	$0	$20.7M
Arizona Surgical Specialists Center, LLC	AZ	Ambulatory Surgical Clinic/Center	$1.4M	$8.1M
Southwest Kidney Davita Dialysis Partners LLC	AZ	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$7.3M
Healthy Life Corporation	AZ	Family Medicine Physician	$0	$6.8M
Clear Vision Ophthalmology PC	AZ	Ophthalmology Physician	$0	$6.3M
Az Pediatric Care	AZ	Primary Care Clinic/Center	$0	$6.3M
Southwest Network, Inc.	AZ	Community/Behavioral Health Agency	$0	$6.1M
Nehad Soloman	AZ	Rheumatology Physician	$5.1M	$0

Banner Estrella Medical Center — 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