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.

Gundersen Lutheran Medical Center Inc (NPI 1376593442)

Key Findings

Field	Value
Entity Type	Organization
Organization	Gundersen Lutheran Medical Center Inc
Address	1910 South Ave
City	La Crosse
State	WI
ZIP	54601
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 11, 2006

Payer Source	Total Paid
Medicaid	$74.3M
Medicare	$0

GUNDERSEN LUTHERAN MEDICAL CENTER INC shows effectively single‑payer activity in the dataset: there is no Medicare billing on file while reported Medicaid revenue totals $74.3M, and the provider’s NPI has been enumerated since 2006-05-11 (~20 years ago), indicating long-standing operations focused on Medicaid reimbursement. This makes Medicaid the dominant revenue stream for analysis and benchmarking.

Revenue is highly concentrated in ambulatory evaluation-and-management services: the precomputed top three Medicaid codes (99214, 99213, 99215) together account for 51.5% of total Medicaid revenue. Individually, 99214 generated $11.3M (23.7%), 99213 generated $9.8M (20.5%), and 99215 generated $3.5M (7.3%), signaling that outpatient/office visit E/M coding is the primary driver of reported Medicaid dollars.

The provider’s code mix points to a hybrid acute-hospital plus high-volume outpatient clinic operation: beyond the top office E/M codes, Medicaid revenues include hospital outpatient clinic visits (G0463, $2.6M, 5.4%), high-acuity ED care (99285, $2M, 4.2%), and substantial infusion services (96361 $2.1M, 4.4%; 96365 $558.4K, 1.2%; 96366 $607.6K, 1.3%). This pattern is consistent with a General Acute Care Hospital that delivers both emergency and ambulatory specialty services alongside infusion and procedural treatments.

State-level competitive standing is dominant for the headline E/M volumes: 99214 ranks #7 of 1628 providers in-state (100th percentile, labeled an "extreme outlier, far above typical state volume"), 99213 ranks #6 of 1755 (100th percentile, "extreme outlier"), and 99215 ranks #2 of 349 (100th percentile, "extreme outlier"). Those rank/percentile positions indicate this provider is a major statewide hub for established-patient outpatient visits under Medicaid.

Laboratory and diagnostic throughput is also a distinguishing feature: the electrolyte panel 80051 is $1M (2.2%) and ranks #1 of 56 providers in-state (100th percentile, another "extreme outlier"), surgical pathology 88305 generated $818.5K (1.7%) and ranks #4 of 194 (98th percentile, "extreme outlier"), and definitive drug testing G0483 produced $1.3M (2.7%) and ranks #3 of 16 (87th percentile). These positions suggest unusually large in-house lab and pathology volume relative to peers statewide.

Emergency department and hospital-ED level coding reinforce significant urgent-care capacity: the hospital ED code G0383 generated $483.5K (1.0%) and ranks #1 of 7 providers in-state (100th percentile, "notably above typical state volume"), while ED E/M levels 99285, 99284, and 99283 all appear on the top list with notable rank percentiles. Together these entries corroborate a substantial ED footprint that complements the high outpatient visit volumes.

Service breadth extends into specialty clinics and behavioral health: ophthalmology code 92014 produced $1.6M (3.3%) and ranks #3 of 413 (100th percentile, "extreme outlier"), behavioral health short-term residential H0018 produced $1.3M (2.8%) and ranks #6 of 41 (88th percentile, "typical, unremarkable volume"), and J0585 botulinum toxin injections contributed $449K (0.9%) and ranks #5 of 32 (87th percentile). This mix indicates the hospital’s Medicaid portfolio includes specialty outpatient clinics and some non-hospital residential behavioral health services in addition to core hospital care.

The dataset flags both extreme outliers and typical volumes across services: several high-revenue E/M and lab codes carry the explicit label "extreme outlier" or "100th percentile," while other commonly billed items such as IV fluid infusion 96361 (20.9K claims, $2.1M, 4.4%) and certain drug-testing and infusion codes are described as "typical, unremarkable volume" or "notably above typical." Analysts should treat the provider as a statewide leader in outpatient E/M and certain diagnostics while recognizing that some ancillary service volumes fall within expected ranges for high-volume hospital systems.

Medicaid: Complete Services Breakdown

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

737 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…	198,680	$60	$11.3M
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…	204,330	$50	$9.8M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	47,120	$70	$3.5M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	108,250	$20	$2.6M
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.	20,880	$100	$2.1M
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.	38,770	$50	$2M
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	30,160	$50	$1.6M
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…	21,180	$70	$1.5M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	7,670	$170	$1.3M
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	24,280	$50	$1.3M

Showing 1–10 of 737

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

Gundersen Lutheran Medical Center Inc — 14 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

737 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	6	40	1,130	$660	$2.3M
H2012	Behavioral health day treatment, per hour	31	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.	8	140	3,200	$160	$1.1M
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	3	20	760	$110	$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.	57	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.	27	430	760	$60	$484.6K
J0178	Injection, aflibercept, 1 mg	5	10	660	$500	$479.6K
L1833	Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf	3	10	70	$190	$457.8K
J0585	Injection, onabotulinumtoxina, 1 unit	5	30	550	$240	$428.8K
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.	70	190	1,790	$90	$390.9K

Showing 1–10 of 737

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mercy Health System Corporation	WI	Multi-Specialty Clinic/Center	$0	$13.2M
Gundersen Clinic Ltd	WI	Clinic/Center	$0	$10.1M
Moundview Memorial Hospital & Clinics, Inc	WI	Critical Access Hospital	$0	$8.9M
Palmer Lutheran Health Center, Inc	IA	Rural Health Clinic/Center	$0	$6M
Memorial Hospital Of Boscobel	WI	Critical Access Hospital	$0	$5.4M
Tri-county Memorial Hospital, Inc.	WI	Critical Access Hospital	$0	$4.1M
Peter Bracha	FL	Retina Specialist (Ophthalmology) Physician	$4M	$0
St. Joseph's Health Services, Inc.	WI	Critical Access Hospital	$0	$3.9M
Palmer Lutheran Health Center, Inc.	IA	Rural Health Clinic/Center	$0	$3.5M
Gundersen Lutheran Medical Center, Inc.	WI	Air Ambulance	$0	$2M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
County Of La Crosse	WI	Community/Behavioral Health Agency	$0	$85M
Mayo Clinic Health System-southwest Wisconsin Region, Inc.	WI	General Acute Care Hospital	$0	$13.4M
Mayo Clinic Health System-southwest Wisconsin Region, Inc.	WI	Multi-Specialty Clinic/Center	$0	$8.8M
Riverfront Activities Center Inc	WI	Developmentally Disabled Services Day Training Agency	$0	$7.2M
La Crosse County Human Services	WI	Community/Behavioral Health Agency	$0	$3.3M
School District Of La Crosse	WI	Local Education Agency (LEA)	$0	$2.8M
Chileda Institute, Inc	WI	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$1.9M
Driftless Recovery Services, Inc.	WI	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$1.4M
Paula Gill	WI	Hematology & Oncology Physician	$997.3K	$0
Cindy Calderon	WI	Ophthalmology Physician	$897.7K	$4.1K

Gundersen Lutheran Medical Center Inc — Billing Profile & Reimbursement Data

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Gundersen Lutheran Medical Center 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