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

Why is the Medicaid comparison limited to Montana 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. Montana (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 James Healthcare (NPI 1528037215)

Field	Value
Entity Type	Organization
Organization	St James Healthcare
Address	400 S Clark St
City	Butte
State	MT
ZIP	59701
Taxonomy	General Acute Care Hospital
NPI Enumerated	March 15, 2006

Payer Source	Total Paid
Medicaid	$1.8M
Medicare	$0

Medicaid: Complete Services Breakdown

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

255 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	27,810	$20	$500.6K
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.	14,610	$10	$175.3K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	3,670	$20	$69.7K
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.	4,610	$10	$64.5K
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.	3,100	$20	$58.8K
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	1,040	$50	$54.1K
G0378	Hospital observation service, per hour	3,980	$10	$47.8K
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.	3,160	$20	$47.4K
J3490	Unclassified drugs	42,240	$1	$42.2K
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…	34,660	$1	$34.7K

Showing 1–10 of 255

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

St James Healthcare — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

255 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	21	60	2,160	$80	$526.7K
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	80	2,770	$60	$471K
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.	4	90	2,330	$40	$281.3K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	17	30	3,780	$40	$222.6K
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.	129	200	1,110	$60	$207.2K
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.	15	50	1,150	$50	$119.8K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	14	40	430	$70	$91.3K
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.	7	40	1,380	$20	$71K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	24	30	470	$80	$64.1K
G0378	Hospital observation service, per hour	8	30	1,610	$20	$60.4K

Showing 1–10 of 255

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Scl Health Montana	MT	General Acute Care Hospital	$0	$13.5M
Kalie Adler	MN	Diagnostic Radiology Physician	$127K	$0
Jay Clark	UT	Radiation Oncology Physician	$110.5K	$0
Zachary Reese	UT	Hematology & Oncology Physician	$83.6K	$0
Rebecca Tarlton	MT	Radiation Oncology Physician	$28.6K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bsw, Inc.	MT	Developmentally Disabled Services Day Training Agency	$0	$20.4M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$14.6M
State Of Montana	MT	Substance Abuse Rehabilitation Facility	$0	$12.7M
Scl Health Medical Group-butte LLC	MT	Family Medicine Physician	$0	$9.9M
Butte Public Schools	MT	Local Education Agency (LEA)	$0	$6.9M
Community, Counseling & Correctional Services, Inc.	MT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$3.8M
Butte School District #1	MT	Mental Health Counselor	$0	$3.8M
Ryan Todorovich	MT	General Practice Dentistry	$0	$3.1M
Lindsey Todorovich	MT	General Practice Dentistry	$0	$2.9M
Silver Bow County Developmental Disabilities Council, Inc.	MT	Developmentally Disabled Services Day Training Agency	$0	$2.2M

St James Healthcare — Billing Profile & Reimbursement Data

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St James Healthcare — 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