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

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

St Lukes Community Hospital (NPI 1336213446)

St Lukes Community Hospital is a critical access hospital provider located in Ronan, Montana. This profile covers 0 Medicare and 168 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	St Lukes Community Hospital
Address	107 6th Ave Sw
City	Ronan
State	MT
ZIP	59864
Taxonomy	Critical Access Hospital
NPI Enumerated	November 20, 2006

Payer Source	Total Paid
Medicaid	$714.7K
Medicare	$0

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

168 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	9,260	$10	$92.6K
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.	6,800	$10	$68K
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.	6,030	$10	$66.4K
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.	1,570	$30	$51.9K
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.	5,430	$10	$48.9K
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…	14,810	$1	$44.4K
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.	4,240	$10	$38.1K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	6,230	$10	$31.1K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	18,410	$1	$18.4K
G0378	Hospital observation service, per hour	2,490	$10	$17.4K

Showing 1–10 of 168

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

St Lukes Community Hospital — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

168 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.	18	60	2,160	$80	$526.7K
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.	23	80	2,770	$60	$471K
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.	37	90	2,330	$40	$281.3K
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…	224	530	580	$70	$224.6K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	24	150	2,760	$40	$224.3K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	32	30	3,780	$40	$222.6K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	28	200	1,110	$60	$207.2K
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…	116	520	730	$40	$196.4K
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.	23	50	1,150	$50	$119.8K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	66	70	420	$80	$111.7K

Showing 1–10 of 168

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Lukes Community Hospital	MT	Urgent Care Clinic/Center	$0	$1.2M
St Lukes Community Hospital	MT	Family Medicine Physician	$0	$824.3K
St Lukes Community Hospital	MT	Rural Health Clinic/Center	$0	$403.3K
Patrick Mcdonnell	NM	Diagnostic Radiology Physician	$142.3K	$0
Valerie Stine	MT	Diagnostic Radiology Physician	$132.8K	$0
Kara Heuvelhorst	WI	Diagnostic Radiology Physician	$131.4K	$0
Michael Henson	MT	Diagnostic Radiology Physician	$129.7K	$0
William Benedetto	MT	Diagnostic Radiology Physician	$122.4K	$0
Andrew Ziegert	WI	Diagnostic Radiology Physician	$120.9K	$0
Kelly Kieper	NM	Diagnostic Radiology Physician	$117.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mission Mountain Enterprises, Inc.	MT	Developmentally Disabled Services Day Training Agency	$0	$17.9M
Ronald Dean	MT	Emergency Medicine Physician	$2.3M	$2.3K
Pal Memory Care, LLC	MT	Assisted Living Facility	$0	$1.7M
School District #30	MT	Local Education Agency (LEA)	$0	$1.4M
Western Montana Family Dentistry	MT	Dentist	$0	$1.2M
Mission Valley Eye Center, Inc.	MT	Optometrist	$0	$1.1M
Rosemary Epperson	MT	Clinical Social Worker	$0	$366.8K
Hikmat Maaliki	MT	Family Medicine Physician	$127K	$0
Marcus Simonich	MT	Optometrist	$60K	$0
Shane Hill	MT	Emergency Medicine Physician	$53.9K	$0

St Lukes Community Hospital — Billing Profile & Reimbursement Data

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St Lukes Community Hospital — 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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