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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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. Vincent Hospital (NPI 1598141152)

St. Vincent Hospital is a urgent care clinic/center provider located in Santa Fe, New Mexico. This profile covers 0 Medicare and 23 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	St. Vincent Hospital
Address	5501 Herrera Dr Ste B
City	Santa Fe
State	NM
ZIP	87507
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	August 6, 2015

Payer Source	Total Paid
Medicaid	$3.2M
Medicare	$0

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

23 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	28,440	$70	$1.9M
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…	8,060	$90	$741.7K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	2,950	$70	$203.3K
99203	The provider sees a new 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 provider…	1,140	$90	$105.6K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	5,240	$20	$83.8K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	4,020	$20	$60.4K
87807	The lab analyst performs the technical lab test to analyze for the presence of respiratory syncytial virus (RSV) in a specimen by immunoassay using direct optical, meaning visual, observation.	1,080	$10	$12.9K
87420	The lab analyst performs a test to detect antigens of respiratory syncytial virus, also called RSV, using an immunoassay technique, such as EIA.	290	$20	$4.7K
99204	The provider sees a new 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 provider…	30	$120	$3.2K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	40	$60	$2.7K

Showing 1–10 of 23

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

St. Vincent Hospital — 2 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

23 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	38	930	910	$80	$521.6K
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…	127	960	1,010	$90	$490K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	82	90	1,570	$30	$183.1K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	278	320	220	$110	$146.2K
99203	The provider sees a new 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 provider…	84	360	220	$90	$134.7K
99204	The provider sees a new 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 provider…	300	380	150	$130	$132.8K
87400	The lab analyst performs the technical lab test to detect antigens of influenza A or B using an immunoassay technique, such as EIA. This analysis will distinguish if a patient has influenza A or B.	9	20	160	$20	$105.8K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	158	240	330	$20	$53.5K
87430	The lab analyst performs an assay to evaluate the patient’s sample for antigens to Streptococcus, group A, using an immunoassay method, such as EIA.	32	50	240	$20	$50.1K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	23	210	350	$20	$42.4K

Showing 1–10 of 23

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Vincent Hospital	NM	General Acute Care Hospital	$0	$46.5M
Mercy Health System Corporation	WI	Multi-Specialty Clinic/Center	$0	$13.2M
St. Vincent Hospital	NM	Pediatrics Physician	$0	$4.7M
St. Vincent Hospital	NM	Pediatrics Physician	$0	$4.4M
St. Vincent Hospital	NM	Hospitalist Physician	$0	$2M
Robert Ali	NM	Hematology & Oncology Physician	$634.6K	$0
David Snyder	NM	Hematology & Oncology Physician	$286.8K	$0
John Garcia	NM	Orthopaedic Surgery Physician	$262.2K	$0
Michael Hoskins	NM	Clinical Cardiac Electrophysiology Physician	$254.2K	$0
Michael Bestawros	NM	Clinical Cardiac Electrophysiology Physician	$251.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Santa Fe Recovery Center Inc	NM	Substance Abuse Rehabilitation Facility	$0	$22M
Presbyterian Healthcare Services	NM	General Acute Care Hospital	$0	$21.6M
Presbyterian Medical Services	NM	Federally Qualified Health Center (FQHC)	$0	$16.4M
Los Amigos, LLC	NM	Case Management Agency	$0	$12.9M
Home Medical Equipment Specialists, LLC	NM	Durable Medical Equipment & Medical Supplies	$0	$11.5M
Teambuilders Behavioral Health, LLC	NM	Community/Behavioral Health Agency	$0	$9.5M
Aspen Medical Group LLC	NM	Urgent Care Clinic/Center	$0	$6.4M
New Vistas	NM	Developmentally Disabled Services Day Training Agency	$0	$6.3M
La Familia Medical Center	NM	Federally Qualified Health Center (FQHC)	$0	$4.7M
Hbj Therapy Services, LLC	NM	Occupational Therapy Assistant	$0	$3.2M

St. Vincent Hospital — Billing Profile & Reimbursement Data

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St. Vincent Hospital — 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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