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

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

Columbia St. Mary's Hospital Milwaukee, Inc. (NPI 1871656082)

Key Findings

Field	Value
Entity Type	Organization
Organization	Columbia St. Mary's Hospital Milwaukee, Inc.
Address	2323 N Lake Dr
City	Milwaukee
State	WI
ZIP	53211
Taxonomy	General Acute Care Hospital
NPI Enumerated	December 18, 2006

Payer Source	Total Paid
Medicaid	$64.5M
Medicare	$0

This provider is effectively single‑payer in our dataset: there is no Medicare billing on file while total Medicaid revenue is $64.5M, so all observed federal payer activity is concentrated in Medicaid. Analysts should treat this profile as Medicaid‑centric when benchmarking or modeling reimbursement exposure.

Revenue concentration is high: the precomputed top 3 Medicaid codes account for 33.1% of this provider's total Medicaid revenue, with the individual top contributors being 99283 ($4.9M, 12.5%), 96361 ($4.4M, 11.3%), and 99284 ($3.6M, 9.2%). This indicates a small set of service types drives a large share of Medicaid dollars for the hospital.

The code mix points to a high‑volume emergency and acute care operation: ED E/M codes appear at the top of the list (99283: 78.5K claims, 99284: 67.9K claims, 99285: 43.6K claims) alongside frequent IV‑fluid/infusion codes (96361: 35.9K claims; 96360/96365 also present). Those volumes and the presence of short‑duration infusion codes suggest substantial ED treatment and observation throughput rather than primarily elective inpatient procedures.

On competitive standing within the state, the provider ranks as a regional leader for several high‑value Medicaid codes: 99283 ranks #5 of 362 (99th percentile, extreme outlier), 96361 ranks #5 of 135 (97th percentile, notably above typical), and 99284 ranks #8 of 432 (98th percentile, notably above typical). These rank/percentile signals indicate the hospital is a dominant Medicaid provider for emergency and infusion services in Wisconsin.

Laboratory and diagnostic throughput is also a major service line: high volumes and revenue for 85025 (133.6K claims, $1.1M, #4 of 299, 99th percentile), 80053 (104.1K claims, $2M, #6 of 261, 98th percentile), and infectious‑disease testing such as U0003 (23.8K claims, $1.9M, #6 of 172, 97th percentile), 87491 and 87591 (each ~38.6K claims). Combined with imaging codes like 70450 (14.6K claims, $977.1K) and 74177 (11.7K claims, $774.6K), the profile indicates robust in‑house lab and advanced imaging capacity supporting high ED and ambulatory volumes.

The provider also records substantial outpatient/clinic E/M activity: 99213 (50K claims, $2.3M, 98th percentile), 99214 (32.9K claims, $887.1K, 98th percentile), and 99212 (43.7K claims, $2.1M, 100th percentile, extreme outlier) are all high on the Medicaid list. This mix suggests that, in addition to emergency services, the hospital delivers large volumes of routine outpatient evaluation and management billed to Medicaid.

The NPI was enumerated on 2006-12-18 (~20 years ago), indicating long tenure in the market. Given that longevity combined with the high state‑percentile rankings across multiple service lines, the hospital should be viewed as an established, major Medicaid provider in Milwaukee for emergency care, infusion services, high‑throughput lab testing, and outpatient E/M encounters.

Medicaid: Complete Services Breakdown

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

597 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	78,460	$60	$4.9M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	35,910	$120	$4.4M
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.	67,880	$50	$3.6M
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…	50,010	$50	$2.3M
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.	43,590	$50	$2.2M
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,…	43,710	$50	$2.1M
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.	104,100	$20	$2M
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…	23,780	$80	$1.9M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	38,590	$30	$1.3M
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.	16,990	$70	$1.1M

Showing 1–10 of 597

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Columbia St. Mary's Hospital Milwaukee, Inc. — 24 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

597 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2012	Behavioral health day treatment, per hour	48	50	8,810	$110	$2.2M
J9271	Injection, pembrolizumab, 1 mg	3	10	200	$1,270	$1.4M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	5	140	3,200	$160	$1.1M
P9016	Red blood cells, leukocytes reduced, each unit	6	10	750	$590	$906.4K
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.	5	360	1,550	$70	$614.4K
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.	8	430	760	$60	$484.6K
S9480	Intensive outpatient psychiatric services, per diem	2	10	2,990	$110	$418.1K
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.	10	190	1,790	$90	$390.9K
G0176	Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more)	37	50	670	$120	$361.8K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	8	140	2,200	$90	$358.4K

Showing 1–10 of 597

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ascension Medical Group-southeast Wisconsin Inc	WI	Internal Medicine Physician	$0	$44.8M
Parkview Health System, Inc.	IN	Internal Medicine Physician	$0	$22.5M
Columbia St. Mary's Hospital Milwaukee, Inc	WI	Multi-Specialty Clinic/Center	$0	$9.8M
Michael Hafran	MI	Family Medicine Physician	$3.7M	$0
Columbia St Mary's Hospital Ozaukee, Inc.	WI	General Acute Care Hospital	$0	$2.1M
Jose Pratts Emanuelli	TN	Diagnostic Radiology Physician	$759.9K	$16.3K
Andrew Hutchens	TN	Diagnostic Radiology Physician	$424.1K	$0
Richard Schmidt	WI	Otolaryngology Physician	$367.6K	$3.7K
Vineet Sharma	TN	Diagnostic Radiology Physician	$286.1K	$63.3K
Adam Bryant	WI	Diagnostic Radiology Physician	$124.4K	$200K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ascension Wisconsin Laboratories, Inc	WI	Clinical Medical Laboratory	$431.4K	$5.8M
North Shore Pathologists Sc	WI	Anatomic Pathology & Clinical Pathology Physician	$0	$2.6M
Infinity Healthcare Physicians, S.c.	WI	Emergency Medicine Physician	$0	$2.5M
Metropolitan Medical Center, LLC	WI	Ambulatory Surgical Clinic/Center	$711.8K	$148.1K
Sandeep Ramanujam	WI	Family Medicine Physician	$495.6K	$85.7K
Loritz Chavez	WI	Hospitalist Physician	$158.5K	$121.4K
Kevin Krembs	WI	Internal Medicine Physician	$125.6K	$0
Nguyen Phan	WI	Clinical Cardiac Electrophysiology Physician	$124.2K	$400
Debra Scarlett	WI	Dermatology Physician	$114.5K	$0
Rashad Khazi Syed	WI	Clinical Cardiac Electrophysiology Physician	$112.2K	$160

Columbia St. Mary's Hospital Milwaukee, Inc. — Billing Profile & Reimbursement Data

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Columbia St. Mary's Hospital Milwaukee, Inc. — 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