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

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

Agnesian Healthcare, Inc (NPI 1346228541)

Key Findings

Field	Value
Entity Type	Organization
Organization	Agnesian Healthcare, Inc
Address	430 E Division St
City	Fond Du Lac
State	WI
ZIP	54935
Taxonomy	General Acute Care Hospital
NPI Enumerated	January 6, 2006

Payer Source	Total Paid
Medicaid	$17.8M
Medicare	$0

AGNESIAN HEALTHCARE, INC is effectively a single-payer facility in these records: there is no Medicare billing on file while Medicaid accounts for the provider’s entire reported lifetime revenue of $17.8M, indicating operational dependence on Medicaid reimbursement for the periods captured. This payer concentration has implications for revenue risk if Medicaid policy or contract rates change.

Revenue concentration within Medicaid is material: the top three Medicaid codes by revenue together account for 35.5% of the provider’s total Medicaid revenue, signaling that a relatively small set of services disproportionately drives the hospital’s Medicaid receipts. That concentration suggests focused operational capacity and exposure tied to those high-volume service lines.

Emergency department evaluation-and-management codes feature prominently among top Medicaid earners, with 99283 ($1.7M, 13.8% of total), 99284 ($894.8K, 7.2%), 99282 ($870.3K, 7.0%), and 99285 ($194.7K, 1.6%) all in the top 25. This mix indicates a high ED utilization and capacity to manage a range of acuity from straightforward to moderate decision-making, consistent with a general acute care hospital that serves significant unscheduled/emergent patient demand.

Infusion and IV fluid management is another major service cluster: 96361 ($1.4M, 11.7%), 96365 ($298.9K, 2.4%), 96366 ($242.8K, 2.0%), and 96360 ($235.5K, 1.9%) together reflect extensive IV therapy throughput, suggesting robust ED and inpatient support services for dehydration, medication infusions, and allied infusion therapies. These codes reinforce the clinical profile implied by the ED-heavy E/M claims.

Behavioral health and therapy services are also significant: 90834 psychotherapy ($1.2M, 10.0%) is an extreme outlier in-state (98th percentile), and therapy/rehabilitation codes such as 97110 ($734.3K, 5.9%), 97140 ($260.4K, 2.1%), 97112 ($242.8K, 2.0%), 97530 ($198.6K, 1.6%), and 99214 office E/M ($347K, 2.8%) show notable volumes. The unusually high ranking for 90834 suggests the provider is a major regional site for psychotherapy services on Medicaid compared with in-state peers.

Diagnostic and laboratory testing volumes are substantial and diversified: high-claim lab panels such as 80053 ($758K, 6.1%), 85025 CBC ($244.2K, 2.0%), 80048 BMP ($206.2K, 1.7%), 87635/87637 COVID/multiplex tests ($234.4K and $295.6K, each ~1.9–2.4%), and troponin 84484 ($262.2K, 2.1%) indicate steady throughput through the hospital’s lab and imaging services. These patterns align with emergency, inpatient, and outpatient diagnostic needs typical for a general acute care hospital.

Geographic competitive standing is mixed but generally above-typical for many codes: several high-volume codes rank in the 83rd–98th state percentiles (for example, 90834 at the 98th, 97110 at the 96th, 85610 at the 98th), indicating AGNESIAN is often a high-volume Medicaid provider in Wisconsin for behavioral health, therapy, and certain lab tests. For key ED codes like 99283 and 99284 the provider sits in the 94th and 91st percentiles, representing typical to unremarkable statewide volumes but still higher than many peers.

Tenure data show the provider’s NPI was enumerated around 2006-01-06 (~20 years ago), indicating long-standing presence in the market. That extended tenure, combined with the concentrated Medicaid revenue and high state-percentile rankings on multiple codes, suggests established operational pipelines for emergency, infusion, therapy, and behavioral health services within the state Medicaid system.

Medicaid: Complete Services Breakdown

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

293 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	31,700	$50	$1.7M
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.	13,550	$110	$1.4M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	28,910	$40	$1.2M
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.	20,340	$40	$894.8K
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.	14,270	$60	$870.3K
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.	31,580	$20	$758K
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…	27,200	$30	$734.3K
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.	5,710	$60	$359.5K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	6,730	$50	$356.8K
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…	6,940	$50	$346.9K

Showing 1–10 of 293

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Agnesian Healthcare, Inc — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

293 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2012	Behavioral health day treatment, per hour	51	50	8,810	$110	$2.2M
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.	18	140	3,200	$160	$1.1M
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.	23	360	1,550	$70	$614.4K
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.	38	430	760	$60	$484.6K
S5136	Companion care, adult (e.g., iadl/adl); per diem	9	10	270	$100	$449.7K
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.	11	190	1,790	$90	$390.9K
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.	24	140	2,200	$90	$358.4K
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.	82	330	1,350	$60	$338K
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…	78	170	720	$70	$272.7K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	14	80	650	$110	$244.4K

Showing 1–10 of 293

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Agnesian Healthcare, Inc	WI	Community Based Hospice Care Agency	$0	$8.8M
Agnesian Healthcare Inc	WI	Family Medicine Physician	$0	$7.4M
Sameer Gupta	PA	Hematology & Oncology Physician	$2.9M	$0
Agnesian Healthcare Inc	WI	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$2.3M
Rahul Sawlani	WI	Diagnostic Radiology Physician	$329.3K	$29.7K
Mary Friess	WI	Family Nurse Practitioner	$328K	$15.8K
Vinod Alluri	TX	Psychiatry Physician	$187.4K	$88.4K
Garry Jean-louis	WI	Infectious Disease Physician	$205.7K	$0
Conrad Brimhall	TN	Dermatology Physician	$189.3K	$880
Bryce Beard	LA	Radiation Oncology Physician	$178.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Consultants Laboratory Of Wisconsin, LLC	WI	Clinical Medical Laboratory	$1.2M	$4.6M
Fond Du Lac County Dcp Case Management	WI	Case Management Agency	$0	$5.8M
Premier Care Of Wisconsin, LLC.	WI	Methadone Clinic	$0	$4.8M
Fond Du Lac Co Dcp Ccs Program	WI	Community/Behavioral Health Agency	$0	$4.3M
Fond Du Lac School District	WI	Local Education Agency (LEA)	$0	$2.5M
Agnesian Healthcare Enterprises LLC	WI	Durable Medical Equipment & Medical Supplies	$0	$2.2M
City Of Fond Du Lac	WI	Land Ambulance	$325.7K	$1.5M
The Arc Of Fond Du Lac	WI	Speech-Language Pathologist	$0	$1.8M
Blandine House Inc	WI	Substance Abuse Rehabilitation Facility	$0	$1.3M
Waupun Memorial Hospital	WI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.2M

Agnesian Healthcare, Inc — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References