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

Why is the Medicaid comparison limited to Texas 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. Texas (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.

Ascension Seton (NPI 1447355771)

Ascension Seton is a children's hospital provider located in Austin, Texas. This profile covers 0 Medicare and 95 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	Ascension Seton
Address	4900 Mueller Blvd
City	Austin
State	TX
ZIP	78723
Taxonomy	Children's Hospital
NPI Enumerated	September 13, 2006

Payer Source	Total Paid
Medicaid	$29.4M
Medicare	$0

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

95 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	25,130	$490	$12.4M
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.	71,410	$130	$9.1M
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.	4,140	$510	$2.1M
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…	15,840	$100	$1.6M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	580	$1,170	$683.9K
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…	5,210	$110	$567.7K
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.	3,930	$130	$526.9K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	16,000	$20	$384K
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…	2,370	$110	$258.3K
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.	1,880	$90	$169.2K

Showing 1–10 of 95

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Texas Distribution

Ascension Seton — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Texas

Full comparison — all codes billed, vs. Texas median

95 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	76	710	1,790	$200	$2.1M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	29	70	370	$760	$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.	19	730	1,960	$100	$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.	150	590	740	$170	$969.2K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	65	70	850	$180	$621.2K
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…	57	340	400	$50	$553.5K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	58	60	340	$590	$491.5K
G0378	Hospital observation service, per hour	56	70	300	$500	$465K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	79	110	80	$1,260	$398.1K
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	135	160	200	$280	$321.8K

Showing 1–10 of 95

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dell Children's Medical Group	TX	Pediatrics Physician	$0	$11.1M
Akbar Hussaini	TX	Orthopaedic Surgery Physician	$157K	$0
Erica Hughes	TX	Pulmonary Disease Physician	$141.8K	$0
Bernard Morris	TX	Urology Physician	$104.4K	$0
Nadia Bening	TX	Psychiatry Physician	$65.5K	$0
Kirby Reed	TX	Family Nurse Practitioner	$32.5K	$0
Amanda Sanders	TX	Nurse Practitioner	$13K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Central Texas Community Health Centers	TX	Federally Qualified Health Center (FQHC)	$0	$28.7M
Austin Regional Clinic, PA	TX	Family Medicine Physician	$0	$14.7M
Brian Leykum	TX	Podiatrist	$196.9K	$0
Jose Grijalva	TX	Psychiatry Physician	$118.3K	$0
Malcolm Duncan	TX	Psychiatric/Mental Health Nurse Practitioner	$106.7K	$0

Ascension Seton — Billing Profile & Reimbursement Data

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Ascension Seton — 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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