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.

Memorial Medical Center Inc (NPI 1437179231)

Key Findings

Field	Value
Entity Type	Organization
Organization	Memorial Medical Center Inc
Address	1615 Maple Ln
City	Ashland
State	WI
ZIP	54806
Taxonomy	Critical Access Hospital
NPI Enumerated	July 21, 2006

Payer Source	Total Paid
Medicaid	$22.6M
Medicare	$0

MEMORIAL MEDICAL CENTER INC is effectively a Medicaid-focused critical access hospital: it has no Medicare billing on file and reports $22.6M in lifetime Medicaid revenue, meaning Medicaid is the dominant and effectively sole publicly billed payer visible in these data. The provider’s NPI was enumerated on 2006-07-21 (~20 years ago), indicating an established operational tenure in the community.

Revenue concentration is strong: the precomputed top three Medicaid codes (99213, 96361, 99284) account for 39.3% of the provider’s total Medicaid revenue, showing a reliance on a small set of services for a large share of Medicaid receipts. This concentration suggests that shifts in reimbursement or utilization for these codes could materially affect overall revenue.

The code mix indicates a blended service-line footprint centered on emergency care, ambulatory office visits, and IV/infusion services. High-revenue ED E/M codes such as 99284 (17K claims, $2.2M revenue) and 99283/99285 also appear on the top list, alongside high-volume office E/M codes like 99213 (34.9K claims, $3.1M revenue) and infusion codes 96361 and 96365, which together signal active emergency department throughput plus substantial outpatient infusion/IV fluid administration.

Infusion and procedural revenue is a notable specialty area: 96361 ($2.4M revenue, $418 avg paid/claim) and 96365 ($931.4K revenue, $202 avg paid/claim) are large contributors, and related codes such as 96366, 96360, 96367, and chemotherapy 96413 also appear on the list. This cluster implies a meaningful workload in IV fluids, infusions, and oncology/infusion-support services within the Medicaid population.

Behavioral health services are a meaningful secondary service line: psychotherapy codes 90834 (13.2K claims, $767.6K revenue; 95th percentile) and 90832 (2.3K claims, $322.6K revenue; 91st percentile), plus group therapy 90853, indicate the hospital provides substantial mental health outpatient services to Medicaid patients. These codes’ state-level percentiles (90834 at the 95th percentile) point to above-typical behavioral health activity relative to peers.

Competitive standing is mixed by code: 99213 ranks #43 of 1755 in-state (98th percentile) yet is described as "typical, unremarkable volume for this code," while ED code 99284 ranks #47 of 432 (89th percentile) and infusion code 96361 ranks #46 of 135 (66th percentile), both labeled "typical, unremarkable volume for this code." A few outpatient visit codes are higher outliers by label—99203 ranks #14 of 440 (97th percentile) and is noted as "notably above typical state volume for this code"—suggesting pockets where the provider exceeds regional norms.

Operational implications for payers and network planners: the hospital’s top revenue drivers (office E/M 99213 and ED E/M 99284 plus infusion 96361) point to a facility that must support both urgent/emergent care workflows and infusion capacity for Medicaid patients. Given the 39.3% revenue concentration in these three codes, managing utilization and contracting around ED and infusion services will be strategic for payers negotiating with or managing care through this provider.

Service-level reimbursement signals are visible in average paid-per-claim figures and rank percentiles: examples include 99213 ($90 avg paid/claim), 96361 ($418 avg paid/claim), and 99284 ($131 avg paid/claim). Those per-claim amounts, together with state ranking information and the provider’s critical access taxonomy, provide payers with concrete benchmarks for negotiating rates, assessing network adequacy, and forecasting Medicaid spend for similar rural acute-care settings.

Medicaid: Complete Services Breakdown

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

217 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…	34,930	$90	$3.1M
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.	5,660	$420	$2.4M
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.	17,040	$130	$2.2M
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.	12,690	$140	$1.8M
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.	9,240	$150	$1.4M
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,…	11,260	$110	$1.3M
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…	15,780	$60	$947K
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.	4,610	$200	$931.4K
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…	13,230	$60	$767.6K
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.	2,220	$250	$544.1K

Showing 1–10 of 217

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

Memorial Medical Center Inc — 5 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

217 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	46	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.	71	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.	47	430	760	$60	$484.6K
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.	78	190	1,790	$90	$390.9K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	16	40	150	$530	$381.9K
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.	35	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.	45	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…	29	170	720	$70	$272.7K
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.	61	260	3,590	$20	$232.2K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	106	190	620	$40	$226.6K

Showing 1–10 of 217

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Medical Services, Inc	WI	Critical Access Hospital	$0	$14.7M
Jesalyn Tate	KS	MOHS-Micrographic Surgery Physician	$121.2K	$0
Kenneth Dornfeld	MN	Radiation Oncology Physician	$101.2K	$0
Dimitrios Giannakidis	TN	Neurology Physician	$78.8K	$0
Scott Mikesell	MN	Interventional Cardiology Physician	$71.3K	$0
Mihailo Lalich	WI	Medical Oncology Physician	$59K	$0
Wangcai Gao	MN	Neurology Physician	$22.7K	$0
Michelle Riley	AZ	Family Nurse Practitioner	$20.7K	$0
Nicholas Miller	WI	Anesthesiology Physician	$12.3K	$0
Thomas D'innocenzo	WI	Certified Registered Nurse Anesthetist	$10.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
County Of Ashland	WI	Public Health or Welfare Agency	$9.1K	$7.5M
Avanti Home Health Services, LLC	WI	Home Health Agency	$0	$3.3M
City Of Ashland	WI	Land Ambulance	$286K	$418.3K
Andrew Matheus	WI	Family Medicine Physician	$60.4K	$160.4K
Kim Ogle	WI	Internal Medicine Physician	$211.8K	$0
Walgreen Co	WI	Pharmacy	$131.8K	$50.7K
Brianne Sable	WI	Physician Assistant	$121.5K	$0
Matthew Horning	WI	Family Medicine Physician	$88K	$0
Katie Smith	WI	Physical Therapist	$64.1K	$0
Stephen Smalley	WI	Cardiovascular Disease Physician	$63.1K	$0

Memorial 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