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

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

Nebraska Methodist Hospital (NPI 1689628372)

Key Findings

Field	Value
Entity Type	Organization
Organization	Nebraska Methodist Hospital
Address	8303 Dodge St
City	Omaha
State	NE
ZIP	68114
Taxonomy	Emergency Medicine Physician
NPI Enumerated	May 19, 2006

Payer Source	Total Paid
Medicaid	$5.3M
Medicare	$0

NEBRASKA METHODIST HOSPITAL shows virtually all of its recorded federal revenue activity in Medicaid with Total Medicaid revenue of $5.3M and no Medicare billing on file; this makes its profile effectively single-payer in the available federal claims data and suggests analyses should focus on Medicaid network positioning and state-level competition. The provider’s NPI was enumerated on 2006-05-19 (~20 years ago), indicating a long tenure in the market; that longevity supports stability in billing patterns and makes year-over-year comparisons meaningful for state Medicaid trends rather than startup behavior. Revenue concentration in Medicaid is meaningful: the precomputed note that the top 3 Medicaid codes account for 49.1% of total Medicaid revenue signals a concentrated service mix, so shifts in utilization or reimbursement for a small set of codes could materially affect overall revenue. Emergency department visit codes are major revenue drivers: 99284 generates $1.3M (25.0% of Medicaid revenue) and 99283 generates $779.1K (14.6%), together representing a substantial share of Medicaid revenue and indicating a high-volume ED operation with mostly low-to-moderate complexity E/M encounters. The provider also reports significant behavioral-health and outpatient volumes, with psychotherapy code 90834 contributing $508.8K (9.5% of Medicaid revenue) and several office visit codes (99213, 99214) together adding meaningful outpatient clinic revenue; this mix suggests the hospital system supports integrated behavioral health and ambulatory services in addition to emergency care. Imaging and obstetric ultrasound are distinctive lines for this provider: codes 76816 ($343.5K, 6.4%), 76819 ($322.1K, 6.0%), and 76815 ($263.6K, 4.9%) each appear high relative to state peers, with 76819 ranking #1 of 11 providers (100th percentile) and 76815 ranking #1 of 20 providers (100th percentile), identifying the hospital as a regional outlier for ultrasound-based prenatal services. Pathology and lab services also contribute meaningfully through surgical pathology codes 88305 ($318.6K, 6.0%) and 88307 ($123.5K, 2.3%), with 88305 ranking #6 of 46 providers (89th percentile), consistent with a facility that performs a steady volume of surgical specimen processing. Competitive standing across key codes is mixed: for major ED codes the provider ranks in the mid-to-upper state percentiles (99284 at the 88th, 99283 at the 87th), indicating strong but not dominant market share for emergency services; for several obstetric ultrasound codes the provider is at or near the top of state volume, marking those service lines as competitive strengths. Given the concentrated Medicaid revenue base and absence of Medicare claims, payer-mix risk is concentrated — any policy, utilization-management, or reimbursement change affecting Medicaid ED, behavioral health, or prenatal ultrasound services could disproportionately impact the provider’s revenue.

Medicaid: Complete Services Breakdown

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

42 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	18,230	$70	$1.3M
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.	12,990	$60	$779.1K
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…	4,310	$120	$508.8K
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…	13,410	$30	$429.2K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	8,380	$40	$343.5K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	7,320	$40	$322.1K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	6,370	$50	$318.6K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	16,970	$20	$271.5K
76815	The provider performs a limited examination of the fetus using ultrasound. The provider performs the examination of certain parameters for one or more fetuses.	7,990	$30	$263.6K
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…	4,160	$50	$216.5K

Showing 1–10 of 42

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

Nebraska Methodist Hospital — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

42 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	14	110	770	$110	$774.3K
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.	19	140	1,100	$110	$607.4K
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.	44	80	300	$120	$519.5K
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…	45	700	660	$70	$305.1K
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…	95	600	610	$70	$251.4K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	6	50	1,140	$60	$200K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	29	50	670	$30	$186.5K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	6	10	1,730	$120	$181.7K
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…	51	510	450	$100	$168.1K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	6	30	1,720	$10	$158.7K

Showing 1–10 of 42

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nebraska Methodist Hospital	NE	General Acute Care Hospital	$0	$14.5M
Thomas Franco	NE	Physical Medicine & Rehabilitation Physician	$526.6K	$0
John Henry	NE	Cardiovascular Disease Physician	$355.7K	$0
Mark Chouinard	NE	Cardiovascular Disease Physician	$323K	$0
Edmund Fiksinski	NE	Interventional Cardiology Physician	$293.9K	$0
Thomas Hejkal	NE	Ophthalmology Physician	$264.5K	$0
William Nester	NE	Interventional Cardiology Physician	$255.8K	$0
Jeffrey Mahoney	NE	Clinical Cardiac Electrophysiology Physician	$254.4K	$0
Herbert Hartman	NE	Cardiovascular Disease Physician	$249.4K	$0
Michael Giitter	NE	Internal Medicine Physician	$225.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital & Medical Center	NE	Children's Hospital	$0	$89.8M
Children's Physicians	NE	Pediatrics Physician	$0	$39.4M
Nebraska Pediatric Practice, Inc	NE	Pediatrics Physician	$0	$29M
Physicians Clinic Inc	NE	Family Medicine Physician	$0	$20.5M
Smiles 4 Kids PC	NE	General Practice Dentistry	$0	$11.5M
Children's Hospital	NE	Pediatric Emergency Medicine (Pediatrics) Physician	$0	$8.4M
Unmc College Of Dentistry	NE	Dentist	$0	$4.8M
Stones Worth Stepping, P.C.	NE	Occupational Therapist	$0	$4.7M
Pacific Surgery Center, LLC	NE	Ambulatory Surgical Clinic/Center	$3.4M	$3.2K
Stefano Tarantolo	NE	Hematology & Oncology Physician	$3.2M	$0

Nebraska Methodist Hospital — Billing Profile & Reimbursement Data

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Nebraska Methodist Hospital — 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