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.

Rushmore Ob-gyn PC (NPI 1316050214)

Field	Value
Entity Type	Organization
Organization	Rushmore Ob-gyn PC
Address	3006 Tower Rd
City	Rapid City
State	SD
ZIP	57701
Taxonomy	Obstetrics & Gynecology Physician
NPI Enumerated	August 16, 2006

Payer Source	Total Paid
Medicaid	$65.5K
Medicare	$0

Medicaid: Complete Services Breakdown

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	50	$760	$34.1K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	310	$20	$7.5K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	60	$90	$5.3K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,300	$1	$5.2K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	100	$50	$5K
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…	80	$30	$2.7K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	40	$40	$1.4K
76805	In this procedure, the provider performs an ultrasound of a pregnant uterus for examination of the first or a single fetus and to examine the mother after the first trimester, or more than 14 weeks…	20	$100	$1.4K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	120	$10	$940
W0037	N/A	190	$1	$580

Showing 1–10 of 14

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

Rushmore Ob-gyn PC — 0 of 14 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

14 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…	272	340	1,010	$100	$511K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	16	20	260	$40	$90.3K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	49	110	990	$20	$82.9K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	16	20	490	$30	$76.2K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	95	160	180	$40	$59.6K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	6	10	1,230	$20	$53.4K
W0037	N/A	130	160	690	$20	$50.1K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	29	50	180	$50	$49.2K
76805	In this procedure, the provider performs an ultrasound of a pregnant uterus for examination of the first or a single fetus and to examine the mother after the first trimester, or more than 14 weeks…	16	20	120	$60	$48.3K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	4	10	40	$500	$28.6K

Showing 1–10 of 14

Rushmore Ob-gyn PC — Billing Profile & Reimbursement Data

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Rushmore Ob-gyn 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

Frequently Asked Questions

References