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

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

Matthew Sanborn (NPI 1285783688)

Field	Value
Entity Type	Individual
Organization	Matthew Sanborn
Address	49 Spring Street
City	Scarborough
State	ME
ZIP	04074
Taxonomy	Neurological Surgery Physician
NPI Enumerated	January 9, 2007

Payer Source	Total Paid
Medicare	$16.1K
Medicaid	$0

Medicare: Complete Services Breakdown

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

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
61645	Using fluoroscopy, live X–rays displayed on a video monitor, the provider inserts a catheter percutaneously (through a small incision in the skin) into an intracranial artery, a branch of the carotid…	20	$650	$13K
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…	20	$100	$2.1K
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…	10	$50	$530
76937	The provider uses ultrasound to help guide procedures requiring vascular access including central venous, peripheral venous, or arterial access procedures.	40	$10	$460

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Maine Distribution

Matthew Sanborn — 0 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. state median

4 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
61645	1	10	20	$660	$11.2K
99213	2,315	2,350	50	$50	$4.3K
99204	458	810	30	$100	$3.6K
76937	6	40	20	$10	$260

Matthew Sanborn — Billing Profile & Reimbursement Data

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Matthew Sanborn — 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