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.

Prohealth Medical Group Inc. (NPI 1356322440)

Prohealth Medical Group Inc. is a pediatrics physician provider located in Waukesha, Wisconsin. This profile covers 0 Medicare and 106 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	Prohealth Medical Group Inc.
Address	N17w24100 Riverwood Dr
City	Waukesha
State	WI
ZIP	53188
Taxonomy	Pediatrics Physician
NPI Enumerated	November 7, 2005

Payer Source	Total Paid
Medicaid	$8.2M
Medicare	$0

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

106 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…	77,800	$30	$2.6M
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…	81,800	$30	$2.1M
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…	17,180	$30	$549.8K
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…	11,830	$40	$437.7K
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.	14,350	$30	$430.6K
99000	Use this code for the in office preparation of a specimen for lab analysis and or its transport from the office to the outside testing laboratory.	70,770	$1	$212.3K
99203	The provider sees a new 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 provider…	4,870	$40	$185.2K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	28,210	$10	$169.2K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	2,790	$50	$128.1K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	4,490	$30	$121.1K

Showing 1–10 of 106

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

Prohealth Medical Group Inc. — 7 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

106 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	26	40	930	$100	$214.5K
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…	24	1,630	270	$40	$205.3K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	10	40	640	$50	$178.5K
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…	24	1,760	250	$40	$173.2K
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.	43	350	300	$50	$157.9K
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…	80	500	3,140	$20	$148.9K
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…	452	630	2,500	$20	$135.5K
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.	15	260	690	$40	$133.8K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	63	150	440	$70	$131.9K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	139	900	410	$70	$130.4K

Showing 1–10 of 106

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Douglas Marx	WI	Family Medicine Physician	$789.6K	$15.9K
Christopher Burnett	WI	MOHS-Micrographic Surgery Physician	$298.5K	$0
Sarfraz Sidhu	WI	Internal Medicine Physician	$232.6K	$0
Hannah Song	WI	Dermatology Physician	$222.3K	$0
David Letzer	WI	Infectious Disease Physician	$213.8K	$0
Matthew Weinberg	WI	Cardiovascular Disease Physician	$170.5K	$0
Mark Hwang	CT	Radiation Oncology Physician	$160.9K	$0
Brian Lee	WI	Dermatology Physician	$158.8K	$0
Ismael Yussuf	DC	Internal Medicine Physician	$154.3K	$2.5K
Zuber Ali	WI	Cardiovascular Disease Physician	$140.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prohealth Waukesha Memorial Hospital, Inc.	WI	General Acute Care Hospital	$0	$21.5M
Waukesha County	WI	Case Management Agency	$0	$18M
Waukesha County	WI	Community/Behavioral Health Agency	$0	$15M
Hometown Hospice & Homecare Inc	WI	Community Based Hospice Care Agency	$0	$12.1M
Neurotech, LLC	WI	Physiological Laboratory	$145.8K	$7.8M
Commonheart, Inc.	WI	Community Based Hospice Care Agency	$0	$7.2M
Kinex Medical Company LLC	WI	Durable Medical Equipment & Medical Supplies	$0	$7.1M
Waukesha County	WI	Community/Behavioral Health Agency	$0	$3.2M
Oxygen One, Inc.	WI	Oxygen Equipment & Supplies (DME)	$0	$2.8M
Waukesha County Community Dental Clinic, Inc.	WI	Dental Clinic/Center	$0	$2.3M

Prohealth Medical Group Inc. — Billing Profile & Reimbursement Data

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Prohealth Medical Group Inc. — 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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