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 St Lukes (NPI 1457309270)

Field	Value
Entity Type	Organization
Organization	Avera St Lukes
Address	305 S State St
City	Aberdeen
State	SD
ZIP	57401
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 4, 2006

Payer Source	Total Paid
Medicaid	$1.5M
Medicare	$0

Medicaid: Complete Services Breakdown

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

85 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	32,340	$20	$485K
A9270	Non-covered item or service	8,070	$20	$161.5K
90999	Use 90999 to report dialysis services or procedures that do not have a specific code.	10,930	$10	$120.2K
88300	The physician, typically a pathologist, performs a level I examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	110	$780	$84.7K
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.	2,020	$40	$78.8K
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	5,670	$10	$73.8K
J3490	Unclassified drugs	780	$90	$73K
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.	1,680	$30	$50.3K
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.	1,220	$40	$49K
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…	1,400	$20	$26.5K

Showing 1–10 of 85

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 St Lukes — 1 of 25 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

85 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J3490	Unclassified drugs	15	20	1,200	$170	$1M
90999	Use 90999 to report dialysis services or procedures that do not have a specific code.	7	30	3,520	$50	$769.4K
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	340	1,010	$100	$511K
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	18	40	270	$180	$281.6K
00170	The provider performs anesthesia services for a patient undergoing an intraoral procedure, including biopsy.	15	20	130	$150	$248.6K
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.	22	40	340	$90	$234.9K
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…	119	260	860	$80	$222.6K
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	60	680	$60	$205.7K
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	18	30	300	$150	$195.3K
90832	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…	60	70	200	$80	$176.7K

Showing 1–10 of 85

Related Providers

Other providers that share a Tax Identification Number (TIN) with Avera St Lukes, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Avera St. Luke's	SD	Family Medicine Physician	$0	$2.3M
Richard Conklin	SD	Hematology & Oncology Physician	$994.4K	$0
Patrick Parker	GA	Urology Physician	$783.5K	$0
Avera St Luke's	SD	Physical Therapist	$0	$607.7K
Avera St Luke's	SD	Emergency Medicine Physician	$0	$595.8K
Avera St. Luke's	SD	Diagnostic Radiology Physician	$0	$559.6K
Susheel Gundewar	SD	Interventional Cardiology Physician	$448.9K	$0
Avera St. Luke's	SD	Psychiatry Physician	$0	$355.4K
Leslie Lenter	SD	Diagnostic Radiology Physician	$324K	$0
Surgical Associates Endoscopy Clinic LLC	SD	Ambulatory Surgical Clinic/Center	$309.3K	$0

Nearby Providers

Other providers in the same ZIP code as Avera St Lukes, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Adjustment Training Center, Inc.	SD	Developmentally Disabled Services Day Training Agency	$0	$40.3M
Northeastern Mental Health Center	SD	Mental Health Counselor	$0	$10.1M
Vision Care Associates, LLP	SD	Optometrist	$0	$6M
Sanford Health Network	SD	General Acute Care Hospital	$0	$4.4M
John Bormes	SD	Ophthalmology Physician	$2.6M	$0
Sanford Health Network	SD	General Acute Care Hospital	$0	$1.9M
Avera At Home	SD	Home Health Agency	$0	$1.6M
Ty Hanson	SD	Dermatology Physician	$1.2M	$0
Fettig And Drake Dds PC	SD	General Practice Dentistry	$0	$1M
Isurgery, LLC	SD	Ambulatory Surgical Clinic/Center	$998.3K	$0

Avera St Lukes — Billing Profile & Reimbursement Data

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Avera St Lukes — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References