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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Avera Mckennan (NPI 1396711016)

Avera Mckennan is a endocrinology, diabetes & metabolism physician provider located in Sioux Falls, South Dakota. This profile covers 0 Medicare and 9 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	Avera Mckennan
Address	1600 S Highline Ave Ste 310
City	Sioux Falls
State	SD
ZIP	57110
Taxonomy	Endocrinology, Diabetes & Metabolism Physician
NPI Enumerated	February 23, 2006

Payer Source	Total Paid
Medicaid	$155.1K
Medicare	$0

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

9 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…	2,760	$40	$105K
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…	480	$70	$31.4K
95251	A provider analyzes and interprets data from a patient’s continuous glucose monitor (CGM) and writes a report based on interpretation. This code represents the professional component of the service…	460	$10	$6.5K
99204	The provider sees a new 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 provider…	60	$70	$4.3K
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…	150	$20	$3.4K
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	290	$10	$2.1K
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…	30	$40	$1.1K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	10	$90	$1K
G2211	Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care…	390	$1	$390

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Avera Mckennan — 0 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	257	340	1,010	$100	$511K
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…	53	260	860	$80	$222.6K
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…	66	70	400	$40	$172.5K
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…	25	70	130	$100	$99K
99204	The provider sees a new 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 provider…	52	80	120	$80	$61.5K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	52	50	200	$70	$50.2K
95251	A provider analyzes and interprets data from a patient’s continuous glucose monitor (CGM) and writes a report based on interpretation. This code represents the professional component of the service…	3	10	530	$20	$13.1K
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	27	40	560	$10	$11.2K
G2211	Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care…	14	40	260	$1	$900

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Childrens Home Society Of South Dakota	SD	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$62.7M
Meadows On Sycamore Inc	SD	Assisted Living Facility	$0	$8.2M
Lisa Hemmingson	SD	Mental Health Counselor	$0	$655.6K
Dr. John W Sivesind, O.d., P.C.	SD	Corneal and Contact Management Optometrist	$0	$520.2K
Bonnie Deen	SD	Mental Health Counselor	$0	$415.7K
Hy-vee Inc	SD	Community/Retail Pharmacy	$245.9K	$0
Precision Vision, Inc	SD	Eyewear Supplier	$0	$150K
Best Life, LLC	SD	Professional Counselor	$0	$133.5K
Jallah Kpanquoi	SD	In Home Supportive Care Agency	$0	$131.6K
Jed Assam	SD	Ophthalmology Physician	$131.3K	$0

Avera Mckennan — Billing Profile & Reimbursement Data

Sign up for Avera Mckennan — Billing Profile & Reimbursement Data policy alerts

Avera Mckennan — Billing Profile & Reimbursement Data

Sign up for Avera Mckennan — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center Fargo	ND	Family Medicine Physician	$0	$75.9M
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Avera Mckennan	SD	Psychiatry Physician	$0	$9.1M
Avera Mckennan	SD	Home Infusion Agency	$0	$6.7M
Avera Mckennan	SD	Air Ambulance	$0	$5.3M
Avera St Marys	SD	Multi-Specialty Clinic/Center	$0	$4.6M
Avera Mckennan	SD	Emergency Medicine Physician	$0	$4.1M
Avera Mckennan	SD	General Acute Care Hospital	$0	$3.7M
Avera Mckennan	SD	Diagnostic Radiology Physician	$0	$3.3M