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.

Southwest Health Center, Inc. (NPI 1669871620)

Southwest Health Center, Inc. is a rural health clinic/center provider located in Platteville, Wisconsin. This profile covers 0 Medicare and 26 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	Southwest Health Center, Inc.
Address	1450 Eastside Rd
City	Platteville
State	WI
ZIP	53818
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	August 15, 2014

Payer Source	Total Paid
Medicaid	$2.3M
Medicare	$0

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

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	20,380	$50	$1.1M
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…	25,540	$40	$919.3K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	1,340	$60	$81.8K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	3,250	$20	$65.1K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	610	$100	$62.6K
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…	860	$60	$47.3K
92015	The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced.	2,940	$10	$17.7K
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	450	$20	$9.3K
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…	90	$70	$6.9K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	170	$40	$6.6K

Showing 1–10 of 26

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

Southwest Health Center, Inc. — 2 of 22 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

26 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	63	1,630	270	$40	$205.3K
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…	55	1,760	250	$40	$173.2K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	394	900	410	$70	$130.4K
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…	295	790	400	$40	$109.6K
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…	144	190	370	$60	$107.4K
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,…	477	690	160	$60	$90.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	182	200	200	$60	$64.2K
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…	380	440	90	$50	$41K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	83	410	210	$30	$40.3K
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…	174	330	110	$70	$37.7K

Showing 1–10 of 26

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southwest Health Center, Inc	WI	Critical Access Hospital	$225.5K	$8.3M
Allison Dunne	WI	Physician Assistant	$1.4M	$0
Emily Guerard	NV	Hematology & Oncology Physician	$1.3M	$0
Ruqin Chen	FL	Hematology & Oncology Physician	$1M	$0
James Heun	WI	Hematology & Oncology Physician	$756.4K	$0
Robert Hegeman	WI	Medical Oncology Physician	$393.7K	$0
Samuel Gibson	WI	Diagnostic Radiology Physician	$241.9K	$0
Benjamin Kleiber	WI	Cardiovascular Disease Physician	$224K	$100
Eric Engelman	IA	Hematology & Oncology Physician	$216.5K	$0
Cenon Buencamino	WI	Diagnostic Radiology Physician	$216.5K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wal-mart Stores East LP	WI	Community/Retail Pharmacy	$159.6K	$2.3K
Joshua Lindsey	WI	Orthopaedic Surgery Physician	$154.3K	$0
Walgreen Co	WI	Pharmacy	$139.9K	$7.6K
Jeffrey White	WI	Family Medicine Physician	$72.6K	$0
Terrence Norton	WI	Psychiatry Physician	$55.8K	$0
Scott Kjar	WI	Foot & Ankle Surgery Podiatrist	$28K	$0
Jacob Hiatt	WI	Family Medicine Physician	$21.1K	$0

Southwest Health Center, Inc. — Billing Profile & Reimbursement Data

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Southwest Health Center, Inc. — 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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