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

Why is the Medicaid comparison limited to Nevada 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. Nevada (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 - Reno LLC (NPI 1801152566)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prime Healthcare Services - Reno LLC
Address	235 W 6th St
City	Reno
State	NV
ZIP	89503
Taxonomy	General Acute Care Hospital
NPI Enumerated	April 6, 2012

Payer Source	Total Paid
Medicaid	$15.2M
Medicare	$0

This provider effectively operates as a Medicaid-revenue hospital: there is no Medicare billing on file and all reported lifetime revenue is Medicaid-based ($15.2M). The absence of any Medicare billing on file means payer mix is heavily skewed toward Medicaid, which has implications for reimbursement rates, revenue stability, and payer contracting leverage compared with peers that bill both programs.

Revenue is highly concentrated in emergency department evaluation-and-management codes: the top three Medicaid codes 99284 ($2.9M, 22.7%), 99285 ($2.7M, 21.1%), and 99283 ($2.3M, 17.6%) together account for 61.4% of the provider’s total Medicaid revenue. This concentration indicates the ED is the primary revenue driver and that a small set of high-volume ED services dominates financial performance.

The code mix points to a high-throughput acute care/ED model with significant ancillary services: in addition to ED E/M codes, the dataset shows material billing for observation (G0378), CT imaging (74177, 70450, 74176), laboratory testing (85025, 80053, G0480, 80307), and frequent infusion/injection codes (96374, 96365, 96372, 96375). This pattern is consistent with a general acute care hospital that manages large volumes of emergency patients who require imaging, labs, short-term observation, and parenteral therapies.

Competitive standing within the state is strong for core ED activity: 99284 ranks #19 of 398 providers in-state (95th percentile) and 99283 ranks #11 of 390 (97th percentile), both labeled as notably above typical state volume. By contrast, 99285 is listed at the 94th percentile but described as typical/unremarkable for that code, suggesting the hospital is a major ED volume player overall while certain high-acuity categories are closer to state norms.

There are specific high-percentile outliers in ancillary services that reinforce the ED/observation focus: 96372 (injections) ranks in the 98th percentile and is described as notably above typical state volume, and several imaging and cardiac test codes (e.g., 93306, 71275, 78452) sit in the upper percentiles though are characterized as typical or unremarkable. These outlier labels indicate unusually elevated utilization of some ED-related treatments and diagnostic services compared with most in-state peers.

Operational and contracting implications follow from the Medicaid concentration and code mix: heavy reliance on ED E/M codes and observation hours (G0378) suggests margins and cash flow are sensitive to state Medicaid fee schedules for those services and to any shifts in outpatient/ED utilization. Payers and analysts should prioritize ED, observation, and high-volume diagnostic reimbursement lines when modeling revenue or negotiating value-based arrangements.

Tenure is long enough to support consistent market presence: the NPI was enumerated 2012-04-06 (~14 years ago), indicating the provider has been operating under this identifier for an extended period and likely has established referral and payer relationships in the region. Historical presence combined with high ED volumes supports the interpretation of the facility as an established acute-care ED hub in Reno.

Although the dataset lists many typical-volume ancillary codes (e.g., G0378 at a mid-percentile, multiple CT and lab codes in the typical range), the overall Medicaid-only profile and the fact that top-3 ED codes drive 61.4% of revenue mark this provider as effectively single-payer from a Medicare/Medicaid viewpoint. That concentration elevates exposure to Medicaid policy changes and suggests competitive differentiation will come from ED throughput, observation capacity, and ancillary imaging/lab services.

Medicaid: Complete Services Breakdown

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

233 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.	37,730	$80	$2.9M
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.	25,570	$110	$2.7M
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.	48,950	$50	$2.3M
G0378	Hospital observation service, per hour	7,160	$90	$644K
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.	3,520	$170	$604.8K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	6,010	$70	$408.7K
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	3,090	$120	$370.3K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	15,240	$20	$259K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	6,410	$40	$224.5K
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…	6,510	$30	$208.2K

Showing 1–10 of 233

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nevada Distribution

Prime Healthcare Services - Reno LLC — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nevada

Full comparison — all codes billed, vs. Nevada median

233 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0378	Hospital observation service, per hour	16	40	4,770	$110	$1.2M
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.	22	350	240	$110	$685.4K
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.	19	400	200	$90	$442.5K
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.	29	140	210	$140	$421K
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.	195	310	680	$50	$373.3K
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…	12	60	680	$60	$364.3K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	45	90	190	$160	$332.4K
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.	11	390	200	$60	$289.8K
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	27	30	290	$60	$260.3K
71275	In this procedure, the provider performs a computed tomographic angiography, or CTA imaging of the chest to get detailed images of the blood vessels but not the heart. He performs this study using a…	24	60	330	$150	$250.4K

Showing 1–10 of 233

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Northern Nevada Hiv Outpatient Program, Education And Services	NV	Federally Qualified Health Center (FQHC)	$0	$8M
Reno Emergency Physicians Association, PLLC	NV	Emergency Medicine Physician	$0	$7.7M
The Life Change Center	NV	Addiction (Substance Use Disorder) Psychologist	$201.5K	$5.7M
Reno Orthopaedic Surgery Center LLC	NV	Ambulatory Surgical Clinic/Center	$5.3M	$0
Saint Marys Medical Group Inc.	NV	Primary Care Clinic/Center	$0	$3.1M
Ridge House, Incorporated.	NV	Substance Abuse Rehabilitation Facility	$0	$2.1M
Cba Healthcare, LLC	NV	Community/Behavioral Health Agency	$0	$1.9M
Western Pathology Consultants, Ltd	NV	Clinical Pathology/Laboratory Medicine Physician	$503.1K	$553.9K
Surgery Center Of Reno, LLC	NV	Ambulatory Surgical Clinic/Center	$371K	$200.3K
Chad Watts	NV	Adult Reconstructive Orthopaedic Surgery Physician	$523.3K	$0

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

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Prime Healthcare Services - Reno LLC — 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

Nearby Providers

Frequently Asked Questions

References