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

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

Sarah Dalton (NPI 1285043232)

Field	Value
Entity Type	Individual
Organization	Sarah Dalton
Address	55 Lake Ave N
City	Worcester
State	MA
ZIP	01655
Taxonomy	Adult Health Nurse Practitioner
NPI Enumerated	August 4, 2014

Payer Source	Total Paid
Medicare	$8.9K
Medicaid	$0

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
36558	The provider places a catheter, without a subcutaneous port or pump in one of the major veins carrying the blood to the heart or directly into the right atrium, to administer medication, nutrients,…	30	$180	$5K
49083	In this procedure, the provider withdraws an abnormal buildup of fluid from the abdominal cavity to relieve pressure and pain or to obtain a sample to submit to a laboratory for analysis. He…	20	$70	$1.6K
62328	The provider obtains a sample of cerebrospinal fluid (CSF) under fluoroscopic or CT imaging guidance and sends the specimen to the laboratory for examination. The provider commonly performs this…	20	$60	$1.2K
77001	Report this code as an add–on code to the primary procedure code, such as central venous access devices (CVAD) placement, replacement, or removal, including accessing the vessel, manipulating the…	40	$10	$460
76937	The provider uses ultrasound to help guide procedures requiring vascular access including central venous, peripheral venous, or arterial access procedures.	40	$10	$380
99152	The provider performing a diagnostic or therapeutic procedure administers medication to reduce consciousness, but not render the patient unconscious or asleep, in a patient five years of age or…	40	$10	$350

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Massachusetts Distribution

Sarah Dalton — 1 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. state median

6 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
36558	13	60	20	$200	$4.1K
49083	62	100	30	$80	$3.4K
62328	1	10	10	$60	$900
99152	292	460	60	$10	$790
77001	40	150	30	$20	$610
76937	103	350	30	$10	$520

Sarah Dalton — Billing Profile & Reimbursement Data

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Sarah Dalton — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References