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

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

Lexington Regional Health Center (NPI 1467417352)

Key Findings

Field	Value
Entity Type	Organization
Organization	Lexington Regional Health Center
Address	1201 N Erie St
City	Lexington
State	NE
ZIP	68850
Taxonomy	Critical Access Hospital
NPI Enumerated	April 20, 2006

Payer Source	Total Paid
Medicaid	$4.2M
Medicare	$0

This provider is effectively single‑payer in the available data: there is no Medicare billing on file while total Medicaid revenue is $4.2M, so analysis of scale and service mix should be framed around Medicaid activity alone. The absence of Medicare revenue suggests the facility’s publicly reported billing footprint is concentrated in Medicaid populations rather than split across traditional Medicare enrollee care.

Revenue is highly concentrated in a small set of codes: the top three Medicaid codes — 99284 ($680.4K, 19.3%), 99283 ($548.3K, 15.5%), and 85025 ($297.1K, 8.4%) — together account for 43.2% of the provider’s total Medicaid revenue. This concentration signals that a limited group of ED evaluation/management and lab services are driving nearly half of Medicaid receipts.

The service-line mix implied by the code portfolio is ED- and ancillary-focused: high-volume ED E/M codes (99284, 99283, 99285, 99282) plus hospital observation (G0378) and high claim counts for routine labs (85025, 80053, 80048, 36415) point to an operational model built around emergency care, short‑term observation, and onsite diagnostic testing. The presence of PT codes (97110, 97161) and obstetric ultrasound (76805) indicates the facility also supports outpatient rehabilitation and basic maternal services, reinforcing a small rural hospital delivering a broad set of community services.

Competitive standing for the facility’s top ED and lab codes is generally modest to mid‑range within Nebraska: 99284 ranks #38 of 112 (67th percentile; typical, unremarkable volume for this code), 99283 ranks #43 of 139 (70th percentile; typical, unremarkable volume for this code), and 85025 ranks #22 of 148 (86th percentile; typical, unremarkable volume for this code). In short, the provider is not a dominant statewide player on its largest codes but frequently operates above the median for similar facilities, consistent with a regional critical access role.

There are notable statistical outliers in utilization patterns: 99211 is reported as an "extreme outlier, far above typical state volume for this code" (4.1K claims, $14 avg paid/claim, $57.5K revenue), and routine venipuncture 36415 shows very high claim volume (6.8K claims) and ranks in the 89th percentile (typical, unremarkable volume for this code). These patterns suggest exceptionally high throughput of low‑acuity outpatient encounters and specimen collection, which can materially affect staffing, throughput, and supply needs despite modest revenue per claim.

Reimbursement mix within Medicaid shows many low‑dollar, high‑volume items alongside mid‑range ED payments: average paid per claim for major ED codes is $304 for 99284, $193 for 99283, and $340 for 99285, while high‑frequency lab draws and basic visits have much lower per-claim payments (e.g., 36415 at $10 avg, 99211 at $14 avg). This combination produces a fiscal profile where operational capacity and claim volume management (throughput, lab capacity, observation bed use) are likely as important to revenue generation as maximizing average payment rates.

Physical therapy and ancillary outpatient services make a material contribution beyond emergency care: 97110 accounts for $268.8K (7.6% of Medicaid revenue) and ranks #37 of 213 in‑state (83rd percentile; typical, unremarkable volume for this code), while 97161 adds $37.4K (1.1% of revenue) and ranks in the 80th percentile. These figures indicate a credible outpatient rehab footprint that complements the ED/observation core, supporting a diversified set of Medicaid revenue streams.

The provider’s NPI tenure (enumerated 2006-04-20, ~20 years ago) indicates a long-standing presence in the community, which aligns with its role as a critical access hospital offering a mix of emergency, observation, diagnostic lab, PT, and basic obstetric services. Longevity combined with the observed utilization and ranking profile suggests an established regional operator with steady Medicaid demand rather than a recent entrant or outlier-wide specialty center.

Medicaid: Complete Services Breakdown

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

106 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.	2,240	$300	$680.4K
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.	2,840	$190	$548.3K
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…	8,740	$30	$297.1K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	4,720	$60	$268.8K
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.	5,150	$50	$262.8K
G0378	Hospital observation service, per hour	940	$230	$215.7K
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.	570	$340	$194.8K
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…	4,310	$20	$103.5K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	490	$180	$89.2K
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.	590	$140	$82.5K

Showing 1–10 of 106

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

Lexington Regional Health Center — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

106 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.	38	110	770	$110	$774.3K
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.	24	40	820	$260	$734.1K
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.	43	140	1,100	$110	$607.4K
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.	35	80	300	$120	$519.5K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	40	40	2,880	$40	$386.7K
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…	144	700	660	$70	$305.1K
G0378	Hospital observation service, per hour	16	30	950	$120	$276.4K
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…	133	600	610	$70	$251.4K
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.	31	40	220	$120	$191.5K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	92	130	650	$40	$179.6K

Showing 1–10 of 106

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lexington Regional Health Center	NE	Rural Health Clinic/Center	$0	$3.2M
Lexington Regional Health Center	NE	Rural Health Clinic/Center	$0	$459.5K
Matthew Rutman	NY	Urology Physician	$277.1K	$39.9K
Lexington Regional Health Center	NE	Emergency Medicine Physician	$0	$293.5K
Joseph Kummer	NE	Cardiovascular Disease Physician	$286.5K	$0
Emily Jones	NE	Family Medicine Physician	$185.9K	$0
Joshua Wray	NE	Foot & Ankle Surgery Podiatrist	$137.7K	$0
Matthew Pouliot	CO	Pain Medicine Physician	$123.5K	$0
Thomas Saylor	FL	Orthopaedic Surgery Physician	$98.7K	$0
Anthony Cook	IA	Family Medicine Physician	$74.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Plum Creek Medical Group, P.C.	NE	Family Medicine Physician	$0	$2.5M
Lexington Family Eyecare	NE	Optometrist	$0	$779.3K
Lawton Counseling, LLC	NE	Mental Health Counselor	$0	$306.8K
Mayra Avalos	NE	Mental Health Counselor	$0	$276.7K
Thomas G Fagot Dds PC	NE	General Practice Dentistry	$0	$254.6K
Raime Misko	NE	Family Nurse Practitioner	$67K	$0
Rebecca Gill	NE	Surgery Physician	$44.7K	$0
Jason Seim	NE	Optometrist	$42.7K	$0

Lexington Regional Health Center — 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