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

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

St Lukes Regional Medical Center (NPI 1770586794)

Field	Value
Entity Type	Organization
Organization	St Lukes Regional Medical Center
Address	190 E Bannock St
City	Boise
State	ID
ZIP	83712
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 23, 2005

Payer Source	Total Paid
Medicaid	$25.1M
Medicare	$0

Key Findings

This provider reports no Medicare billing on file and $25.1M in Total Medicaid revenue, making it effectively a Medicaid-focused billing profile; the lack of Medicare activity means Medicaid drives the provider’s scale and reimbursement exposure rather than a dual-payer mix. Analysts should treat payer-concentration risk and service planning through a Medicaid lens for this entity.

Revenue concentration is high: the precomputed top-3 Medicaid codes account for 38.2% of the provider’s Medicaid revenue, driven by 42820 ($2.5M, 15.5%), J1745 ($1.9M, 11.9%), and 97530 ($1.7M, 10.8%). This level of concentration indicates a relatively small set of services materially shapes overall Medicaid receipts.

The code mix indicates a strong pediatric surgical footprint: high-revenue ENT procedures appear repeatedly (42820 – $2.5M, 15.5%; 42830 – $396.3K, 2.4%; 69436 – $1.1M, 6.9%), with 69436 ranked #2 of 23 providers in-state (95th percentile). These volumes suggest the hospital operates a sizable pediatric ENT service line and captures a meaningful share of state pediatric procedural volume.

Biologic infusion and specialty drug administration are material revenue drivers: J1745 (infliximab) generates $1.9M (11.9%) and ranks #1 of 2 providers in-state (100th percentile), and additional oncology/immunology biologics (J9312, J9310, J0897) together add several hundred thousand dollars. The rank and dollar levels imply the hospital is a primary infusion site in-state for certain high-cost biologics.

Outpatient clinic and therapy throughput is a defining operational characteristic: G0463 shows 86K claims and $1.5M (9.0%) and ranks #1 of 21 providers in-state (100th percentile), while therapy codes like 97530 (25.7K claims, $1.7M, 10.8%) and 97110 (19.5K claims, $525.3K, 3.2%) are notably above typical state volumes. Together these data indicate substantial outpatient visit and rehabilitation capacity, positioning the provider as a high-volume ambulatory care hub in-state.

Laboratory and basic inpatient/outpatient diagnostics are extreme outliers for the state: 80053 (62.9K claims, $440.1K) ranks #1 of 72 providers in-state (100th percentile; extreme outlier) and 85025 (82.3K claims, $411.5K) ranks #1 of 90 providers in-state (100th percentile; extreme outlier). These exceptionally large test volumes point to centralized lab operations that drive both throughput and ancillary revenue relative to peers.

Emergency department activity is present but more moderate relative to the provider’s other high-volume lines: 99283 accounts for 7.2K claims and $421.9K (2.6%) and ranks #15 of 83 providers in-state (83th percentile), while 99284 is 5.7K claims and $308.6K (1.9%) and ranks #17 of 75 (78th percentile). This profile suggests a steady ED caseload that contributes to overall volume but is not the dominant revenue engine.

The provider’s NPI has been enumerated since 2005-05-23 (~21 years ago), and state-level rankings show a mixed competitive standing: the hospital is a dominant in-state provider for outpatient clinic visits and several lab test volumes (multiple #1, 100th percentile entries) and a primary site for certain biologic infusions, while for a number of procedural and ED codes it holds typical or modest positions relative to statewide peers. This combination indicates established tenure with concentrated leadership in select Medicaid service lines rather than across all clinical categories.

Medicaid: Complete Services Breakdown

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

512 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	980	$2,560	$2.5M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	760	$2,550	$1.9M
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	25,740	$70	$1.7M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	86,010	$20	$1.5M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	22,070	$60	$1.2M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	1,010	$1,110	$1.1M
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.	5,930	$130	$753.1K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	19,460	$30	$525.3K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	62,870	$10	$440.1K
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.	7,150	$60	$421.9K

Showing 1–10 of 512

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

St Lukes Regional Medical Center — 12 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

512 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1	10	530	$2,300	$1.2M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	11	20	500	$820	$662.5K
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.	24	60	1,080	$110	$595.5K
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.	17	80	1,020	$90	$502.7K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	14	280	1,480	$70	$389.4K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	17	210	3,020	$50	$389K
J9312	Injection, rituximab, 10 mg	1	10	210	$1,880	$384.5K
J0585	Injection, onabotulinumtoxina, 1 unit	3	10	300	$510	$359.7K
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.	15	80	880	$70	$265.5K
J9310	Injection, rituximab, 100 mg	1	10	150	$1,750	$259.1K

Showing 1–10 of 512

Related Providers

Other providers that share a Tax Identification Number (TIN) with St Lukes Regional Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Lukes Clinic-treasure Valley LLC	ID	Family Medicine Physician	$0	$59.2M
St Luke's Clinic LLC	ID	Family Medicine Physician	$0	$39.5M
St Lukes Clinic-treasure Valley LLC	ID	Family Medicine Physician	$0	$6.9M
St Lukes Clinic-treasure Valley LLC	OR	Rural Health Clinic/Center	$0	$2.1M
St Luke's Regional Medical Center	ID	Home Health Agency	$0	$1.6M
St Lukes Regional Medical Center	ID	Critical Access Hospital	$0	$940.7K
Peter Castellanos	ID	Neurology with Special Qualifications in Child Neurology Physician	$0	$599.5K
St Luke's Regional Medical Center	ID	Community Based Hospice Care Agency	$0	$397.2K
David Mcnaul	MO	Diagnostic Radiology Physician	$269.4K	$0
Benjamin Bridges	MD	Hematology & Oncology Physician	$248.9K	$0

Nearby Providers

Other providers in the same ZIP code as St Lukes Regional Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Home Society Of Idaho	ID	Mental Health Counselor	$0	$2.1M
Boise Pathology Group P.A.	ID	Dermatopathology (Pathology) Physician	$0	$1.1M
Casey Mcroy	ID	Diagnostic Radiology Physician	$648.3K	$0
Frederick Emge	ID	Pediatric Cardiology Physician	$0	$422.8K
Dentistry For Children	ID	Pediatric Dentistry	$0	$343.1K
Sarah Bolender	ID	Radiation Oncology Physician	$245.1K	$0
Marcos Daccarett	ID	Clinical Cardiac Electrophysiology Physician	$202.3K	$0
Tonya Kuhn	ID	Radiation Oncology Physician	$187.9K	$0
Kenneth Little	ID	Neurological Surgery Physician	$179.9K	$0
Stephen Smith	ID	Radiation Oncology Physician	$161.1K	$0

St Lukes Regional Medical Center — Billing Profile & Reimbursement Data

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St Lukes Regional Medical Center — 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