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

Why is the Medicaid comparison limited to Minnesota 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. Minnesota (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 Marshall (NPI 1568401016)

Avera Marshall is a critical access hospital provider located in Marshall, Minnesota. This profile covers 0 Medicare and 124 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Avera Marshall
Address	300 S Bruce St
City	Marshall
State	MN
ZIP	56258
Taxonomy	Critical Access Hospital
NPI Enumerated	June 6, 2006

Payer Source	Total Paid
Medicaid	$10M
Medicare	$0

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

124 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.	12,020	$100	$1.2M
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.	8,430	$120	$994.4K
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…	17,060	$50	$835.8K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	21,900	$40	$810.3K
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.	6,530	$100	$678.8K
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.	2,770	$230	$636.6K
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…	7,990	$70	$575.1K
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.	5,160	$100	$495.1K
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…	4,160	$110	$436.3K
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…	7,610	$50	$357.9K

Showing 1–10 of 124

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Minnesota Distribution

Avera Marshall — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Minnesota

Full comparison — all codes billed, vs. Minnesota median

124 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	42	80	6,550	$80	$4.4M
J0178	Injection, aflibercept, 1 mg	6	10	80	$1,620	$1.9M
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.	48	160	580	$170	$1.8M
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.	49	210	980	$140	$1.7M
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.	44	220	1,730	$120	$1.3M
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…	241	1,180	1,150	$80	$605.7K
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…	44	110	1,880	$50	$564.6K
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…	137	1,200	1,030	$70	$549.7K
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.	60	260	890	$60	$405.3K
90834	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…	217	620	560	$80	$361.9K

Showing 1–10 of 124

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Affiliated Community Medical Centers, Ltd	MN	Multi-Specialty Clinic/Center	$0	$4.7M
Jeffrey Stevens	CA	Retina Specialist (Ophthalmology) Physician	$1.8M	$0
Chris Buntrock	NM	Ophthalmology Physician	$1M	$0
Angelo Santos	SD	Vascular Surgery Physician	$434.5K	$0
Bradley Close	MN	Diagnostic Radiology Physician	$397.3K	$0
Neil Bansal	NJ	Neuroradiology Physician	$351.9K	$0
Orvar Jonsson	SD	Advanced Heart Failure and Transplant Cardiology Physician	$315.3K	$0
Kelly Steffen	SD	Cardiovascular Disease Physician	$276.3K	$0
Ajay Shalwala	MN	Ophthalmology Physician	$222.3K	$44.2K
Joseph Billings	FL	Orthopaedic Surgery Physician	$236.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Western Mental Health Center, Inc.	MN	Mental Health Counselor	$0	$16.7M
Rural Health Care, Inc	MN	Federally Qualified Health Center (FQHC)	$0	$10.1M
Southwest Health And Human Services	MN	Case Management Agency	$0	$7.8M
Advance Opportunities	MN	Developmentally Disabled Services Day Training Agency	$0	$5.9M
Hy-vee Inc	MN	Community/Retail Pharmacy	$199.7K	$8.1K
Curtis Louwagie	MN	Ophthalmology Physician	$190.7K	$0
Walmart Inc.	MN	Community/Retail Pharmacy	$84K	$0
Kirsten Verly	MN	Physical Therapist	$62.1K	$0
Dean Bruns	MN	Chiropractor	$46.8K	$0
Kelly Dvorak	MN	Chiropractor	$30.7K	$0

Avera Marshall — Billing Profile & Reimbursement Data

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Avera Marshall — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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