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

Why is the Medicaid comparison limited to Iowa 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. Iowa (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 Anthony Regional Hospital And Nursing Home (NPI 1801815972)

St Anthony Regional Hospital And Nursing Home is a family medicine physician provider located in Carroll, Iowa. This profile covers 0 Medicare and 35 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	St Anthony Regional Hospital And Nursing Home
Address	311 S Clark St
City	Carroll
State	IA
ZIP	51401
Taxonomy	Family Medicine Physician
NPI Enumerated	July 19, 2006

Payer Source	Total Paid
Medicaid	$1.1M
Medicare	$0

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

35 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…	12,290	$30	$344.2K
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…	7,820	$40	$289.5K
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…	1,590	$90	$143K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	2,650	$40	$116.6K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	1,350	$40	$54K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	1,100	$40	$40.6K
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	810	$40	$33.3K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	710	$40	$29.1K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	1,520	$20	$28.9K
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…	260	$70	$18.2K

Showing 1–10 of 35

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Iowa Distribution

St Anthony Regional Hospital And Nursing Home — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Iowa

Full comparison — all codes billed, vs. Iowa median

35 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	103	120	1,100	$30	$162.6K
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…	119	1,060	480	$40	$154.5K
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…	138	1,310	760	$20	$153.1K
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…	34	140	210	$120	$152.1K
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…	98	170	540	$50	$101.2K
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…	128	190	300	$50	$91.7K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	16	80	250	$50	$87.1K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	60	250	240	$30	$72.7K
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	26	90	320	$40	$58.8K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	27	210	170	$60	$50.6K

Showing 1–10 of 35

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Robert Behrens	IA	Medical Oncology Physician	$5.2M	$0
James Stafford	TX	Radiation Oncology Physician	$1.5M	$0
St Anthony Regional Hospital And Nursing Home	IA	Critical Access Hospital	$0	$1.4M
Boris Naydich	MD	Radiation Oncology Physician	$892.3K	$0
Joshua Lukenbill	IA	Medical Oncology Physician	$534.1K	$0
Said Sana	WV	Family Medicine Physician	$424.4K	$0
Matthew Carpenter	IL	Radiation Oncology Physician	$420.8K	$0
Robert Isaak	IA	Radiation Oncology Physician	$172.7K	$0
Adam Althaus	SD	Urology Physician	$137.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carroll Co Council Prev Child Abuse	IA	Community/Behavioral Health Agency	$0	$51M
New Hope Village, Inc	IA	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$50.2M
Ability United LLC	IA	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$43.8M
Homecare Options, Inc.	IA	Contractor	$0	$9.1M
Caring Hearts Of West Central Iowa	IA	Community Health Worker	$0	$3.4M
Region Xii Council Of Governments, Inc.	IA	Non-emergency Medical Transport (VAN)	$0	$1.9M
Carroll Community School District	IA	Local Education Agency (LEA)	$0	$1.3M
Carroll County County Auditor	IA	Ambulance	$344K	$824.9K
Carroll Dental Clinic P.l.c.	IA	Dentist	$0	$1.1M
Wellendorf Ent, P.C.	IA	Otolaryngology Physician	$0	$932.9K

St Anthony Regional Hospital And Nursing Home — 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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