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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Sanford Health Network (NPI 1790721280)

Field	Value
Entity Type	Organization
Organization	Sanford Health Network
Address	20 S Plum St
City	Vermillion
State	SD
ZIP	57069
Taxonomy	Critical Access Hospital
NPI Enumerated	June 22, 2006

Payer Source	Total Paid
Medicaid	$274.4K
Medicare	$0

Medicaid: Complete Services Breakdown

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

22 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J3490	Unclassified drugs	390	$260	$99.5K
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…	2,120	$20	$42.5K
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.	990	$40	$40.4K
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.	750	$40	$31.6K
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…	1,020	$20	$18.3K
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.	350	$40	$15.2K
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.	110	$80	$8.9K
90999	Use 90999 to report dialysis services or procedures that do not have a specific code.	770	$10	$6.2K
87081	The lab analyst cultures a patient specimen on a test medium designed to grow only a specific pathogenic organism.	60	$50	$3.1K
0241U	N/A	20	$130	$2K

Showing 1–10 of 22

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Sanford Health Network — 0 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

22 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J3490	Unclassified drugs	18	20	1,200	$170	$1M
90999	Use 90999 to report dialysis services or procedures that do not have a specific code.	22	30	3,520	$50	$769.4K
90863	The provider prescribes and reviews medications for pharmacological management after psychotherapy services at the same encounter.	12	10	5,650	$90	$550.2K
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…	118	340	1,010	$100	$511K
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.	15	40	340	$90	$234.9K
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…	121	260	860	$80	$222.6K
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.	26	60	680	$60	$205.7K
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.	43	70	1,150	$50	$155.9K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	37	50	1,650	$10	$125.4K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	24	30	330	$40	$104.9K

Showing 1–10 of 22

Related Providers

Other providers that share a Tax Identification Number (TIN) with Sanford Health Network, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Sanford Health Network	MN	Rural Acute Care Hospital	$0	$7.6M
Sanford Health Network	IA	Family Medicine Physician	$0	$6.6M
Sanford Clinic	SD	Diagnostic Radiology Physician	$0	$6M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M
Sanford Health Network	SD	General Acute Care Hospital	$0	$4.4M
Sanford Clinic	SD	Hospitalist Physician	$0	$2.9M
Willamette Orthopedic Group LLC	OR	Orthopaedic Surgery Physician	$0	$2.7M
Sanford Clinic	SD	Family Medicine Physician	$0	$2M
Gustavo Westin	FL	Medical Oncology Physician	$2M	$0

Nearby Providers

Other providers in the same ZIP code as Sanford Health Network, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sesdac, Inc.	SD	Developmentally Disabled Services Day Training Agency	$0	$26.2M
Sanford Health Network	SD	Family Medicine Physician	$0	$1.3M
Sesdac, Inc.	SD	Case Management Agency	$0	$422.8K
Sesdac, Inc.	SD	Case Management Agency	$0	$395.7K
Knutson Familty Dentistry LLP	SD	Dentist	$0	$306.6K
Houska Dental Clinic	SD	Dental Clinic/Center	$0	$303.3K
Brown Optometric Clinic PC	SD	Optometrist	$0	$238.2K
Great Plains Therapy LLC	SD	Physical Therapy Clinic/Center	$0	$219.7K
City Of Vermillion	SD	Land Ambulance	$164.7K	$52.4K
Allison Walsh	SD	Mental Health Counselor	$0	$185.5K

Sanford Health Network — Billing Profile & Reimbursement Data

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Sanford Health Network — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References