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

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

St Luke's Jones Regional Medical Center (NPI 1497255269)

Field	Value
Entity Type	Organization
Organization	St Luke's Jones Regional Medical Center
Address	105 9th Ave
City	Belle Plaine
State	IA
ZIP	52208
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	February 18, 2018

Payer Source	Total Paid
Medicaid	$1.3M
Medicare	$0

Medicaid: Complete Services Breakdown

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	12,470	$100	$1.3M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	230	$10	$1.1K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	800	$1	$800
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	170	$1	$660
3008F	No Summary found for this code	220	$0	$0
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,390	$0	$0
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	10	$0	$0
90656	This code represents a preservative–free trivalent influenza vaccine product containing split virus components. It is administered into the muscle in a 0.5 mL dosage.	30	$0	$0
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	320	$0	$0
99173	The provider checks the eyesight in both eyes of a pediatric patient by asking him to read letters of varying sizes on a standard chart, such as a Snellen’s chart, which he keeps 20 feet away from…	220	$0	$0

Showing 1–10 of 15

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Iowa Distribution

St Luke's Jones Regional Medical Center — 0 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Iowa

Full comparison — all codes billed, vs. Iowa median

15 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	97	330	3,960	$170	$2.8M
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…	216	1,060	480	$40	$154.5K
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…	225	1,310	760	$20	$153.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	90	250	110	$50	$39.9K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	192	460	820	$1	$19K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	115	290	100	$40	$17.2K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	113	570	110	$10	$11.4K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	170	190	250	$10	$11K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	146	520	100	$10	$6.1K
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…	31	90	180	$10	$5.6K

Showing 1–10 of 15

St Luke's Jones Regional Medical Center — Billing Profile & Reimbursement Data

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St Luke's Jones Regional Medical Center — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Frequently Asked Questions

References