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.

Avera Queen Of Peace (NPI 1861639197)

Avera Queen Of Peace is a pediatrics physician provider located in Mitchell, South Dakota. This profile covers 0 Medicare and 31 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	Avera Queen Of Peace
Address	1900 Grassland Dr
City	Mitchell
State	SD
ZIP	57301
Taxonomy	Pediatrics Physician
NPI Enumerated	January 8, 2009

Payer Source	Total Paid
Medicaid	$286.5K
Medicare	$0

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

31 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…	2,710	$40	$97.6K
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…	950	$50	$51.1K
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…	730	$60	$39.9K
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.	750	$40	$31.3K
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…	480	$50	$25.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	200	$50	$10K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	810	$10	$7.3K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	340	$20	$5.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	80	$60	$4.7K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	810	$10	$4.1K

Showing 1–10 of 31

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

Avera Queen Of Peace — 0 of 24 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

31 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	103	340	1,010	$100	$511K
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…	125	260	860	$80	$222.6K
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…	25	40	1,100	$80	$181.3K
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…	23	50	410	$80	$127.2K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	147	160	210	$120	$97.4K
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.	10	30	150	$40	$72.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	26	60	170	$90	$66.3K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	18	20	110	$80	$60K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	49	160	180	$40	$59.6K
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…	35	50	180	$50	$49.2K

Showing 1–10 of 31

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Avera Mckennan	SD	Diagnostic Radiology Physician	$0	$3.3M
Avera Mckennan	SD	Maternal & Fetal Medicine Physician	$0	$2.3M
Ayham Deeb	VA	Hematology & Oncology Physician	$1.9M	$0
Avera Mckennan	SD	Pediatrics Physician	$0	$1.4M
Avera Queen Of Peace	SD	Critical Access Hospital	$0	$1.3M
Kathleen Naegele	IL	Hematology & Oncology Physician	$805.1K	$57.9K
Avera Queen Of Peace	SD	Rural Acute Care Hospital	$0	$803.8K
Abbas Chamsuddin	IL	Diagnostic Radiology Physician	$368.8K	$114.2K
Neil Bansal	NJ	Neuroradiology Physician	$351.9K	$0
Avera Queen Of Peace	SD	Clinical Medical Laboratory	$0	$286.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lifequest	SD	Developmentally Disabled Services Day Training Agency	$0	$53.1M
Abbott House, Inc.	SD	Psychiatric Residential Treatment Facility	$0	$28.1M
Lifequest	SD	Case Manager/Care Coordinator	$0	$13.2M
Dakota Counseling Institute, Inc.	SD	Mental Health Counselor	$0	$9.7M
Dakota Solace Home Care	SD	In Home Supportive Care Agency	$0	$4.9M
Rural Health Care, Inc	SD	Federally Qualified Health Center (FQHC)	$0	$4.4M
Rosewood Court	SD	Assisted Living Facility	$0	$2.7M
Sanford Clinic	SD	Obstetrics & Gynecology Physician	$0	$1.2M
Dpt Inc	SD	Home Health Agency	$0	$835.1K
Mitchell Clinic Ltd	SD	Family Medicine Physician	$0	$619.4K

Avera Queen Of Peace — Billing Profile & Reimbursement Data

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Avera Queen Of Peace — 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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