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.

Athol Memorial Hospital Incorporated (NPI 1336120047)

Athol Memorial Hospital Incorporated is a critical access hospital provider located in Athol, Massachusetts. This profile covers 0 Medicare and 235 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	Athol Memorial Hospital Incorporated
Address	2033 Main Street
City	Athol
State	MA
ZIP	01331
Taxonomy	Critical Access Hospital
NPI Enumerated	November 9, 2005

Payer Source	Total Paid
Medicaid	$30.8M
Medicare	$0

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

235 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	17,000	$280	$4.8M
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…	15,270	$280	$4.3M
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.	19,080	$180	$3.5M
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.	19,620	$170	$3.3M
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.	20,550	$150	$3.1M
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…	15,290	$120	$1.9M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	4,210	$400	$1.7M
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.	3,790	$190	$730.9K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	4,250	$130	$547.9K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	5,060	$110	$531.4K

Showing 1–10 of 235

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Athol Memorial Hospital Incorporated — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

235 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	52	90	7,560	$350	$4.2M
S9485	Crisis intervention mental health services, per diem	106	110	1,250	$540	$3.2M
G0378	Hospital observation service, per hour	51	70	7,250	$100	$1.3M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	44	80	4,380	$140	$1.1M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	57	110	5,660	$30	$1.1M
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.	62	520	120	$130	$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…	36	130	1,830	$60	$974.3K
96366	The provider administers an intravenous infusion or infusions of a medication for an additional hour or subsequent hours after the first hour to prevent, treat, or diagnose a condition or disease.	36	60	1,750	$260	$907.4K
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.	59	550	110	$120	$865.5K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	256	410	140	$110	$742.2K

Showing 1–10 of 235

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Henry Heywood Memorial Hospital	MA	General Acute Care Hospital	$0	$54.5M
Lawrence Proano	RI	Emergency Medicine Physician	$48.4K	$2.3M
Thomas Miller	MA	Family Medicine Physician	$364.5K	$448.2K
Ashok Joshi	MA	Internal Medicine Physician	$188.9K	$530.5K
Tricia Vorderstrasse	MA	Family Medicine Physician	$256.7K	$217.4K
Cheryl Divito	MA	Family Medicine Physician	$49.7K	$345.1K
Payam Aghassi	MA	Pulmonary Disease Physician	$340.5K	$9.4K
Joshua Albrektson	MN	Diagnostic Radiology Physician	$264.9K	$2K
Eugene Kim	MN	Diagnostic Radiology Physician	$248.2K	$16.1K
Mansoor Zaidi	MA	Internal Medicine Physician	$147.4K	$114.1K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pierre Alfred	MA	Ophthalmology Physician	$509.5K	$0
Richard Pineo	MA	Family Nurse Practitioner	$25.7K	$0

Athol Memorial Hospital Incorporated — Billing Profile & Reimbursement Data

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Athol Memorial Hospital Incorporated — 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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