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

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

Saint Mary's Health Services (NPI 1639111057)

Key Findings

Field	Value
Entity Type	Organization
Organization	Saint Mary's Health Services
Address	200 Jefferson Ave Se
City	Grand Rapids
State	MI
ZIP	49503
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 11, 2006

Payer Source	Total Paid
Medicaid	$92M
Medicare	$0

SAINT MARY'S Health Services is effectively a single-payer Medicaid provider: there is no Medicare billing on file and reported Medicaid revenue totals $92M. This concentration means the facility’s public revenue exposure is highly dependent on Medicaid reimbursement and utilization patterns rather than balanced Medicare/Medicaid mix.

Revenue is heavily concentrated in a small set of outpatient and emergency care codes — the precomputed top three Medicaid codes account for 60.7% of the provider’s total Medicaid revenue. The leading codes driving that share are G0463 (342.5K claims, $61 avg paid/claim, $20.9M revenue (28.8% of this provider's total Medicaid revenue)), 99285 (42.6K claims, $314 avg paid/claim, $13.4M revenue (18.4%)), and 99284 (50.4K claims, $194 avg paid/claim, $9.8M revenue (13.5%)).

The code mix indicates the organization operates a high-volume emergency department together with a busy hospital outpatient clinic: G0463 describes hospital outpatient clinic visits for assessment and management, and the next-highest revenue drivers are ED E/M codes 99285, 99284, and 99283. High claim counts for ED levels across the spectrum (for example 99283 64.4K claims and 99282 21.8K claims) point to a broad case mix in emergency care rather than a focus on a single acuity.

Competitive standing is mixed by service line: for outpatient clinic assessment G0463 the provider ranks #4 of 153 in-state (98th percentile) and is notably above typical state volume for that code, signaling market strength in outpatient assessment services. By contrast the ED codes 99285 (rank #41 of 404, 90th percentile) and 99284 (rank #36 of 477, 93th percentile) place the provider as a high-volume but not exclusive ED participant statewide — strong relative scale but not a single dominant ED across all peers.

Preventive care and immunization activity is an outsized part of the profile: multiple preventive visit codes are extreme outliers in-state (for example 99391 22.2K claims ranks #11 of 587, 98th percentile; 99393 14.9K claims ranks #7 of 724, 99th percentile), and vaccination administration codes 90471 (66.3K claims) and 90472 (28K claims) both rank at the top of peers (90471 rank #3 of 1477, 100th percentile; 90472 rank #3 of 666, 100th percentile). This indicates a substantial volume of well visits and vaccine delivery alongside acute care.

Ancillary treatment and procedural support services are also material to Medicaid revenue: outpatient infusion/IV codes such as 96374 (39K claims, $3.7M revenue) and 96375 (28K claims, $784.2K revenue) show routine infusion and medication administration throughput, while imaging and lab codes such as 74177, 70450, U0003, 87637 and 80307 appear in the top 25 list, reflecting integrated imaging and diagnostic capacity in the facility. These lines support both the ED and outpatient clinic activity.

The provider’s revenue profile suggests operational sensitivity to changes in ED and outpatient clinic volume because the top three codes together drive a majority of Medicaid revenue and are centered on assessment and ED E/M services. Any payer policy, utilization management, or local care-delivery shift that affects ED visits or outpatient assessment billing could disproportionately impact reported Medicaid revenue.

The provider has an established presence: the NPI was enumerated on 2006-06-11 (~20 years ago), indicating roughly two decades of operation under this identifier, which is consistent with a mature hospital offering both emergency and broad outpatient/preventive services. This tenure helps explain the breadth of high-volume codes and the standing among in-state peers.

Medicaid: Complete Services Breakdown

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

615 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	342,480	$60	$20.9M
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.	42,570	$310	$13.4M
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.	50,430	$190	$9.8M
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.	64,370	$120	$7.9M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	38,980	$100	$3.7M
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.	21,790	$70	$1.6M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	22,150	$60	$1.4M
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…	23,460	$60	$1.3M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	19,880	$70	$1.3M
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.	8,100	$140	$1.1M

Showing 1–10 of 615

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

Saint Mary's Health Services — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

615 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	4	150	5,330	$50	$2.8M
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.	41	400	1,510	$190	$2.6M
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	4	10	160	$180	$2.3M
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.	36	480	1,350	$110	$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.	24	450	1,540	$90	$1.3M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	10	150	7,610	$90	$1.2M
G0378	Hospital observation service, per hour	34	100	2,820	$180	$1.1M
81220	The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR…	13	10	190	$180	$910.5K
G0382	Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is…	3	10	8,080	$80	$743.9K
J0585	Injection, onabotulinumtoxina, 1 unit	6	40	260	$510	$684.9K

Showing 1–10 of 615

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Advantage Health Saint Mary's Medical Group	MI	Multi-Specialty Clinic/Center	$0	$21.9M
Advantage Health/saint Mary's Medical Group	MI	Multi-Specialty Clinic/Center	$0	$17M
Byron Slaton	MI	Nephrology Physician	$245.5K	$0
April Rosalez	MI	Family Medicine Physician	$99.7K	$0
Sara Karnib	MI	Cardiovascular Disease Physician	$89.5K	$0
Kate Holtze	MI	Cardiovascular Disease Physician	$83.2K	$0
Beth Gehan	MI	Anesthesiology Physician	$45.5K	$0
Wen Chung	MI	Anesthesiology Physician	$22.6K	$0
Jonathon Kivela	MI	Anesthesiology Physician	$21.8K	$0
Joel Stracke	MI	Surgery Physician	$16.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spectrum Health Hospitals	MI	General Acute Care Hospital	$0	$243.2M
Kent County Cmh Authority	MI	Community/Behavioral Health Agency	$0	$97.6M
Cancer & Hematology Centers Of Western Mi, P.C.	MI	Specialist	$0	$59.5M
Cherry Street Services, Inc.	MI	Federally Qualified Health Center (FQHC)	$0	$50.9M
Ecs Western Michigan PC	MI	Emergency Medicine Physician	$0	$50.6M
Neo Natal Associates Plc	MI	Neonatal-Perinatal Medicine Physician	$0	$27.7M
Spectrum Health Hospitals	MI	Hospitalist Physician	$0	$25.2M
Life Ems Inc	MI	Land Ambulance	$3.1M	$22M
Cherry Street Services, Inc.	MI	Federally Qualified Health Center (FQHC)	$0	$24.6M
Paramed Inc	MI	Ambulance	$1.8M	$21.1M

Saint Mary's Health Services — Billing Profile & Reimbursement Data

Sign up for Saint Mary's Health Services — Billing Profile & Reimbursement Data policy alerts

Saint Mary's Health Services — Billing Profile & Reimbursement Data

Sign up for Saint Mary's Health Services — Billing Profile & Reimbursement Data policy alerts

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