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.

Prohealth Waukesha Memorial Hospital, Inc. (NPI 1629056890)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prohealth Waukesha Memorial Hospital, Inc.
Address	725 American Ave
City	Waukesha
State	WI
ZIP	53188
Taxonomy	General Acute Care Hospital
NPI Enumerated	January 6, 2006

Payer Source	Total Paid
Medicaid	$21.5M
Medicare	$0

PROHEALTH WAUKESHA MEMORIAL HOSPITAL, INC. is effectively a single-payer facility in the available data, with no Medicare billing on file and $21.5M in lifetime Medicaid revenue reported; this means Medicaid claims drive all observed public-payer activity and any analysis should treat the provider as Medicaid-focused for the period covered.

Revenue concentration in Medicaid is moderately focused: the precomputed top-three codes account for 32.3% of the provider's total Medicaid revenue, indicating a substantial share of Medicaid dollars come from a relatively small set of service lines and that targeted changes to those services could materially affect Medicaid revenue.

Emergency department evaluation-and-management codes are major revenue drivers: 99283 ($2.2M, 15.6%) and 99284 ($1.3M, 9.7%) together represent a large share of Medicaid revenue and reflect a high-volume ED operation handling a mix of low- to moderate-acuity visits, supported by substantial ancillary testing. The combination of high ED E/M volumes with observation-hours code G0378 ($345.3K) suggests ED throughput and observation services are important operational components.

High-volume laboratory and imaging services are also central to the Medicaid mix: U0003 (SARS-CoV-2 testing) and panel codes 80053 and 85025 each contribute roughly 7.0%–3.0% of Medicaid revenue, and 80050 ranks #3 in-state for its code. These patterns point to heavy use of on-site lab capacity and diagnostic imaging in outpatient and ED settings, consistent with a full-service acute-care hospital.

The provider shows strong in-state volume for several therapy and rehab codes: 97530 ranks in the 98th percentile and 97140 in the 97th percentile for the state, while 97112 and 97110 are also high-volume relative to peers. This indicates an above-typical outpatient rehabilitation footprint within Medicaid, suggesting a notable physical/occupational therapy service line contributing to overall revenue.

For many common lab and ED codes the provider sits in high state percentiles but is not a market outlier: codes such as 99283 (96th), 99284 (95th), U0003 (92nd), 80053 (96th), and 85025 (96th) are described as typical or unremarkable volumes relative to peers, meaning the provider is a busy hospital in Wisconsin but generally within expected ranges for similarly sized facilities rather than being a unique statistical extreme.

Some services are clearly above typical state volumes and constitute strategic strengths: 97530 (98th percentile) and 80050 (3rd of 114 providers, 98th percentile) are both flagged as notably above typical state volume, identifying specific lines—therapy and general health panels—where the hospital outperforms most in-state peers and likely captures referral or ambulatory demand.

The NPI enumeration date (2006-01-06) indicates the hospital has been registered for ~20 years, suggesting an established presence in the local market; combine that tenure with high-percentile volumes across multiple codes and the profile aligns with a mature acute-care center with consistent Medicaid activity rather than a new entrant or a small specialty clinic.

Medicaid: Complete Services Breakdown

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

363 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.	37,180	$60	$2.2M
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.	28,550	$50	$1.3M
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…	14,510	$70	$971.8K
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.	69,280	$10	$969.9K
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.	8,820	$110	$952.8K
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.	26,540	$30	$663.6K
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…	10,720	$50	$503.7K
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.	8,770	$60	$482.3K
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.	7,440	$60	$431.2K
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…	70,230	$10	$421.4K

Showing 1–10 of 363

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

Prohealth Waukesha Memorial Hospital, Inc. — 9 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

363 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2012	Behavioral health day treatment, per hour	33	50	8,810	$110	$2.2M
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.	32	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.	16	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.	24	430	760	$60	$484.6K
J0585	Injection, onabotulinumtoxina, 1 unit	14	30	550	$240	$428.8K
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.	63	190	1,790	$90	$390.9K
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.	14	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.	48	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…	14	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.	11	260	3,590	$20	$232.2K

Showing 1–10 of 363

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
John Roddy	WI	Critical Care Medicine (Internal Medicine) Physician	$130.6K	$1.1K
Matthew Powell	MN	Clinical Psychologist	$19.5K	$0
Eben Schwartz	WI	Clinical Neuropsychologist	$10.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Waukesha County	WI	Case Management Agency	$0	$18M
Waukesha County	WI	Community/Behavioral Health Agency	$0	$15M
Hometown Hospice & Homecare Inc	WI	Community Based Hospice Care Agency	$0	$12.1M
Prohealth Medical Group Inc.	WI	Pediatrics Physician	$0	$8.2M
Neurotech, LLC	WI	Physiological Laboratory	$145.8K	$7.8M
Commonheart, Inc.	WI	Community Based Hospice Care Agency	$0	$7.2M
Kinex Medical Company LLC	WI	Durable Medical Equipment & Medical Supplies	$0	$7.1M
Waukesha County	WI	Community/Behavioral Health Agency	$0	$3.2M
Oxygen One, Inc.	WI	Oxygen Equipment & Supplies (DME)	$0	$2.8M
Waukesha County Community Dental Clinic, Inc.	WI	Dental Clinic/Center	$0	$2.3M

Prohealth Waukesha Memorial Hospital, Inc. — Billing Profile & Reimbursement Data

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Prohealth Waukesha Memorial Hospital, 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