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.

Agnesian Healthcare Inc (NPI 1730162991)

Agnesian Healthcare Inc is a family medicine physician provider located in Fond Du Lac, Wisconsin. This profile covers 0 Medicare and 122 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	Agnesian Healthcare Inc
Address	420 E Division St
City	Fond Du Lac
State	WI
ZIP	54935
Taxonomy	Family Medicine Physician
NPI Enumerated	November 22, 2005

Payer Source	Total Paid
Medicaid	$7.4M
Medicare	$0

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

122 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…	90,320	$30	$2.3M
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…	45,060	$30	$1.5M
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.	14,840	$30	$460K
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…	12,880	$30	$360.5K
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…	5,230	$60	$293K
98941	The provider applies manipulation to influence joint and neurophysiological function by a variety of techniques and modalities in three to four spinal regions.	13,940	$20	$250.9K
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…	4,160	$60	$245.7K
90960	The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the…	2,510	$80	$198.5K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	26,980	$10	$161.9K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	1,560	$80	$129.3K

Showing 1–10 of 122

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

Agnesian Healthcare Inc — 4 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

122 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	127	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.	56	430	760	$60	$484.6K
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.	85	190	1,790	$90	$390.9K
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.	141	330	1,350	$60	$338K
90960	The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the…	10	30	1,050	$70	$320.9K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	21	20	50	$400	$216.3K
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…	33	1,630	270	$40	$205.3K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	79	120	400	$180	$186.8K
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…	18	1,760	250	$40	$173.2K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	39	150	440	$70	$131.9K

Showing 1–10 of 122

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Agnesian Healthcare, Inc	WI	General Acute Care Hospital	$0	$17.8M
Agnesian Healthcare, Inc	WI	Community Based Hospice Care Agency	$0	$8.8M
Sameer Gupta	PA	Hematology & Oncology Physician	$2.9M	$0
Agnesian Healthcare Inc	WI	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$2.3M
Rahul Sawlani	WI	Diagnostic Radiology Physician	$329.3K	$29.7K
Mary Friess	WI	Family Nurse Practitioner	$328K	$15.8K
Vinod Alluri	TX	Psychiatry Physician	$187.4K	$88.4K
Garry Jean-louis	WI	Infectious Disease Physician	$205.7K	$0
Conrad Brimhall	TN	Dermatology Physician	$189.3K	$880
Bryce Beard	LA	Radiation Oncology Physician	$178.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Consultants Laboratory Of Wisconsin, LLC	WI	Clinical Medical Laboratory	$1.2M	$4.6M
Fond Du Lac County Dcp Case Management	WI	Case Management Agency	$0	$5.8M
Premier Care Of Wisconsin, LLC.	WI	Methadone Clinic	$0	$4.8M
Fond Du Lac Co Dcp Ccs Program	WI	Community/Behavioral Health Agency	$0	$4.3M
Fond Du Lac School District	WI	Local Education Agency (LEA)	$0	$2.5M
Agnesian Healthcare Enterprises LLC	WI	Durable Medical Equipment & Medical Supplies	$0	$2.2M
City Of Fond Du Lac	WI	Land Ambulance	$325.7K	$1.5M
The Arc Of Fond Du Lac	WI	Speech-Language Pathologist	$0	$1.8M
Blandine House Inc	WI	Substance Abuse Rehabilitation Facility	$0	$1.3M
Waupun Memorial Hospital	WI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.2M

Agnesian Healthcare Inc — Billing Profile & Reimbursement Data

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Agnesian Healthcare 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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