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.

Sidney Health Center (NPI 1376617191)

Sidney Health Center is a clinic/center provider located in Sidney, Montana. This profile covers 0 Medicare and 31 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	Sidney Health Center
Address	214 14th Ave Sw
City	Sidney
State	MT
ZIP	59270
Taxonomy	Clinic/Center
NPI Enumerated	November 20, 2006

Payer Source	Total Paid
Medicaid	$1.1M
Medicare	$0

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

31 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	5,850	$80	$491.5K
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…	1,240	$120	$145.3K
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…	1,380	$100	$138.2K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	2,010	$40	$80.5K
99392	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…	680	$110	$74.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	1,780	$20	$26.8K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	1,010	$20	$20.2K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	710	$20	$16.3K
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…	190	$80	$14.9K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	620	$20	$11.1K

Showing 1–10 of 31

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

Sidney Health Center — 0 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

31 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	28	30	770	$60	$233.3K
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…	186	530	580	$70	$224.6K
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	520	730	$40	$196.4K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	25	30	640	$90	$188.1K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	13	20	40	$1,180	$169.3K
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…	17	70	420	$80	$111.7K
99392	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…	28	70	310	$90	$107.1K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	22	50	620	$40	$101K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	67	80	130	$80	$43.2K
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…	82	190	130	$70	$37.2K

Showing 1–10 of 31

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Belmond Community Hospital	IA	Rural Health Clinic/Center	$0	$1.9M
Michael Schekall	MN	Diagnostic Radiology Physician	$1.7M	$710
William Winn	MN	Diagnostic Radiology Physician	$997.1K	$0
Neil Anand	MN	Diagnostic Radiology Physician	$529.9K	$58.1K
Sidney Health Center	MT	Critical Access Hospital	$0	$549.8K
Sidney Health Center	MT	Emergency Care Clinic/Center	$0	$415.3K
Sidney Health Center	MT	In Home Supportive Care Agency	$0	$373.8K
Mark Ellis	MN	Specialist	$337.9K	$0
Jong-ho Choi	MN	Diagnostic Radiology Physician	$326K	$0
Richard Wilson	MN	Diagnostic Radiology Physician	$304.5K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Richland Opportunities Incorporated	MT	Developmentally Disabled Services Day Training Agency	$0	$7.6M
Shc 2021 LLC	MT	Air Ambulance	$1.2M	$42.4K
Prairie Hills Recovery Center	MT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$820.6K
Sidney Eye Care PLLC	MT	Optometrist	$0	$447.7K
Fink Dental Center	MT	Dental Clinic/Center	$0	$423.4K
Sidney Public Schools	MT	Community/Behavioral Health Agency	$0	$326.6K
Lincare Inc	MT	Durable Medical Equipment & Medical Supplies	$0	$302K
Sunrise Wellness Center, LLC	MT	Community/Behavioral Health Agency	$0	$242.7K
County Of Richland	MT	Public Health or Welfare Agency	$78.1K	$67.2K
Kristin O'brien	MT	Optometrist	$66.6K	$0

Sidney Health Center — Billing Profile & Reimbursement Data

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Sidney Health Center — 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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