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

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

Prime Healthcare Services - Monroe LLC (NPI 1740686443)

Prime Healthcare Services - Monroe LLC is a general acute care hospital provider located in Bloomington, Indiana. This profile covers 0 Medicare and 67 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	Prime Healthcare Services - Monroe LLC
Address	4011 S Monroe Med Park Blvd
City	Bloomington
State	IN
ZIP	47403
Taxonomy	General Acute Care Hospital
NPI Enumerated	November 7, 2014

Payer Source	Total Paid
Medicaid	$5.7M
Medicare	$0

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

67 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.	18,790	$150	$2.7M
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.	9,940	$110	$1M
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.	5,920	$90	$544.9K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	1,950	$150	$292.1K
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.	1,230	$160	$201.1K
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.	320	$460	$147.3K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	3,060	$40	$125.4K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	2,260	$50	$115.3K
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	1,420	$70	$102K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	1,920	$50	$90.1K

Showing 1–10 of 67

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Indiana Distribution

Prime Healthcare Services - Monroe LLC — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. Indiana median

67 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.	114	380	2,470	$100	$1.5M
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.	82	360	3,490	$110	$1.5M
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.	95	330	1,530	$100	$1.1M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	88	100	2,210	$70	$926K
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	92	130	3,770	$60	$617.7K
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.	85	150	440	$100	$545.6K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	107	220	1,850	$30	$449.4K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	180	190	800	$40	$344.7K
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…	85	90	1,150	$60	$289.6K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	61	120	3,340	$30	$283.4K

Showing 1–10 of 67

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Centerstone Of Indiana, Inc.	IN	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$318.8M
Southern Indiana Pediatrics, LLC	IN	Pediatrics Physician	$0	$10.7M
Limestone Health, LLC	IN	Methadone Clinic	$116.1K	$9M
Hands At Home, LLC	IN	Home Health Agency	$0	$4.1M
Bloomington Pediatric Dentistry L.L.C.	IN	Pediatric Dentistry	$0	$3.1M
Integ Health System, P.C.	IN	Ambulatory Surgical Clinic/Center	$1.8M	$403.1K
Joseph Mackey	IN	Ophthalmology Physician	$2M	$0
Southern Indiana Surgery Center, LLC	IN	Ambulatory Surgical Clinic/Center	$1.4M	$516.1K
Warren Chang	IN	Ophthalmology Physician	$1.5M	$0
Bloomington Advanced Surgery Center, LLC	IN	Ambulatory Surgical Clinic/Center	$1.1M	$0

Prime Healthcare Services - Monroe LLC — Billing Profile & Reimbursement Data

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Prime Healthcare Services - Monroe LLC — 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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