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

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

Thedacare Medical Center - Shawano, Inc. (NPI 1548260839)

Key Findings

Field	Value
Entity Type	Organization
Organization	Thedacare Medical Center - Shawano, Inc.
Address	100 County Road B
City	Shawano
State	WI
ZIP	54166
Taxonomy	Critical Access Hospital
NPI Enumerated	July 28, 2005

Payer Source	Total Paid
Medicaid	$32.8M
Medicare	$0

This provider is effectively a Medicaid-focused Critical Access Hospital: there is no Medicare billing on file and total Medicaid revenue on file is $32.8M, indicating Medicaid is the dominant (and in this dataset the sole) payer source to analyze. The provider's NPI was enumerated 2005-07-28 (~21 years ago), consistent with an established local acute-care presence in Shawano, WI.

Revenue is concentrated in a small set of emergency and infusion codes: the precomputed top three Medicaid codes account for 47.0% of the provider's Medicaid revenue. Specifically, 99283 generated $5.9M (20.8%), 99284 generated $4.2M (14.8%), and 96361 generated $3.2M (11.4%), so these three codes drive nearly half of Medicaid receipts and should be the primary focus for revenue management and contract negotiations.

The codes mix points to a high-volume emergency department and infusion/IV fluids service line: 99283 (42.4K claims, $140 avg paid/claim), 99284 (25.7K claims, $164 avg paid/claim), and 99282 (21.8K claims, $146 avg paid/claim) together show heavy ED utilization at low-to-moderate acuity levels. Complementing that, multiple infusion and IV-related codes such as 96361 (7.8K claims), 96365 (8K claims), 96366 (1.9K claims), and 96360 (1.9K claims) indicate regular treatment for dehydration and IV therapies, implying the hospital operates as a regional stabilization and short-stay treatment center.

Competitive standing within Wisconsin is strong for several ED and lab codes: 99283 ranks #12 of 362 providers in-state (97th percentile; notably above typical state volume) and 99282 ranks #7 of 191 (97th percentile; notably above typical state volume), signaling that this facility is a major in-state provider for these common ED visit levels. The lab code 80048 also ranks high at #8 of 219 (97th percentile; notably above typical state volume), which supports the view of a busy ED-supported laboratory.

For higher-acuity ED care and many diagnostic services the provider is a solid but not dominant statewide participant: 99285 (5.5K claims) ranks in the 78th percentile and several CT codes such as 74177 and 70450 sit in the 83rd–84th percentile ranges. Infusion code 96361 is at the 75th percentile (#34 of 135 providers), and most imaging and procedure codes are described as typical or unremarkable statewide volumes, indicating capacity for diagnostics but less market dominance outside core ED services.

There are high-value but lower-volume procedural items that contribute meaningfully to revenue: for example, 41899 shows $463.8K revenue with a $1414 avg paid/claim, and 96361 carries a $417 avg paid/claim. These higher average-paid-per-claim codes, while smaller in share than the top ED E/M codes, represent important revenue contributors and potential negotiation targets for specialized procedures and infusion-related reimbursement.

Operationally, the code mix and volume pattern are consistent with a rural Critical Access Hospital model focused on emergency stabilization, IV/infusion therapy, and on-site diagnostic imaging and labs. Given that the top three codes represent 47.0% of Medicaid revenue, payer and provider analysts should prioritize ED E/M and infusion reimbursement rates when assessing financial health or contract strategy for this facility.

The complete absence of Medicare billing on file is notable for a hospital with ~21 years of enumeration and warrants follow-up: analysts should confirm whether Medicare claims are routed through a different entity, subject to data suppression, or reflect an operational footprint concentrated on Medicaid populations. This single-payer appearance in the dataset increases concentration risk and makes Medicaid reimbursement trends especially material to the provider’s financial outlook.

Medicaid: Complete Services Breakdown

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

251 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.	42,400	$140	$5.9M
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.	25,690	$160	$4.2M
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.	7,790	$420	$3.2M
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.	21,850	$150	$3.2M
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.	7,980	$240	$1.9M
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.	4,830	$310	$1.5M
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.	4,880	$280	$1.4M
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.	5,540	$180	$1M
99281	The provider sees a patient for the lowest level emergency department visit.	4,440	$160	$696.9K
96366	The provider administers an intravenous infusion or infusions of a medication for an additional hour or subsequent hours after the first hour to prevent, treat, or diagnose a condition or disease.	1,900	$270	$511.6K

Showing 1–10 of 251

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Thedacare Medical Center - Shawano, Inc. — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

251 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	34	140	3,200	$160	$1.1M
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.	12	360	1,550	$70	$614.4K
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.	31	430	760	$60	$484.6K
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.	7	190	1,790	$90	$390.9K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	14	40	150	$530	$381.9K
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.	16	140	2,200	$90	$358.4K
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.	73	330	1,350	$60	$338K
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…	133	170	720	$70	$272.7K
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.	163	260	3,590	$20	$232.2K
96360	The provider introduces a catheter intravenously for supplementation of fluid and electrolytes for 31 minutes to one hour to treat severe cases of dehydration.	42	110	1,280	$90	$224.5K

Showing 1–10 of 251

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thedacare Regional Medical Center-neenah, Inc.	WI	General Acute Care Hospital	$0	$18.3M
Thedacare, Incorporated	WI	Family Medicine Physician	$0	$14.8M
Thedacare Regional Medical Center - Appleton, Inc.	WI	General Acute Care Hospital	$0	$11.5M
Thedacare Medical Center - Waupaca, Inc.	WI	Critical Access Hospital	$0	$10.9M
Thedacare Medical Center - Berlin, Inc.	WI	Critical Access Hospital	$0	$9.4M
Thedacare Medical Center - New London, Inc.	WI	Critical Access Hospital	$0	$9.2M
Thedacare Medical Center - Wild Rose, Inc	WI	Critical Access Hospital	$0	$6M
The Neuroscience Group Of Northeast Wisconsin Sc	WI	Neurological Surgery Physician	$0	$3.9M
Michael Yuz	FL	Diagnostic Radiology Physician	$410.4K	$92.4K
Richard Santa Cruz	WI	Cardiovascular Disease Physician	$477.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
County Of Shawano	WI	Community/Behavioral Health Agency	$0	$9.5M
Kristin Floss	WI	Behavior Analyst	$0	$3M
County Of Shawano	WI	Community/Behavioral Health Agency	$0	$2.3M
Shawano Ambulance Service, Inc.	WI	Paramedic	$371.3K	$1.7M
Bridge The Gap, Inc	WI	Community/Behavioral Health Agency	$0	$1.2M
Manali Amin	WI	Nurse Practitioner	$12.4K	$8.5K

Thedacare Medical Center - Shawano, Inc. — Billing Profile & Reimbursement Data

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Thedacare Medical Center - Shawano, Inc. — 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