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

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

Benefis Hospitals, Inc. (NPI 1881650737)

Benefis Hospitals, Inc. is a general acute care hospital provider located in Great Falls, Montana. This profile covers 0 Medicare and 523 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	Benefis Hospitals, Inc.
Address	1101 26th St S
City	Great Falls
State	MT
ZIP	59405
Taxonomy	General Acute Care Hospital
NPI Enumerated	April 20, 2006

Payer Source	Total Paid
Medicaid	$3.5M
Medicare	$0

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

523 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0378	Hospital observation service, per hour	18,180	$20	$436.3K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	19,770	$10	$276.8K
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.	27,220	$10	$272.2K
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.	26,650	$10	$266.5K
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.	16,990	$10	$203.9K
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	2,590	$50	$140.1K
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.	18,620	$10	$130.3K
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.	8,480	$20	$127.1K
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.	5,260	$20	$89.3K
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.	8,100	$10	$81K

Showing 1–10 of 523

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Benefis Hospitals, Inc. — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

523 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	16	20	1,510	$170	$848K
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.	20	60	2,160	$80	$526.7K
D2930	N/A	17	20	2,090	$120	$493.4K
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.	15	80	2,770	$60	$471K
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.	6	90	2,330	$40	$281.3K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	9	150	2,760	$40	$224.3K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	7	30	3,780	$40	$222.6K
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.	4	200	1,110	$60	$207.2K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	11	20	40	$1,180	$169.3K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	8	20	970	$100	$148K

Showing 1–10 of 523

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Benefis Hospitals Inc	MT	Multi-Specialty Clinic/Center	$0	$38.2M
West Mont	MT	Adult Care Home Facility	$0	$34.7M
Union Associated Physicians Clinic, LLC	IN	Family Medicine Physician	$0	$31.1M
Benefis Hospitals, Inc.	MT	Air Ambulance	$0	$5.2M
Syed Akbar	IL	Diagnostic Radiology Physician	$280.8K	$223.7K
Michele Degregorio	MI	Cardiovascular Disease Physician	$436.4K	$0
David Reisman	NH	Hematology & Oncology Physician	$366.8K	$0
James Haug	CO	Diagnostic Radiology Physician	$326.9K	$0
Noman Malik	GA	Diagnostic Radiology Physician	$326.1K	$0
Scott Pargot	MT	Otolaryngology Physician	$57.3K	$263.5K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Great Falls Public Schools	MT	Local Education Agency (LEA)	$0	$15M
Great Falls Pediatric Dentistry, LLC	MT	Pediatric Dentistry	$0	$14.9M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$13.2M
Great Falls Clinic LLC	MT	Multi-Specialty Clinic/Center	$0	$11.2M
Easterseals-goodwill Northern Rocky Mountain, Inc.	MT	Developmentally Disabled Services Day Training Agency	$0	$7.4M
Levi C Maltby Dmd P.C.	MT	Dentist	$0	$6M
Great Falls Emergency Services Inc	MT	Land Ambulance	$842.6K	$4.4M
Easterseals Goodwill N. Rocky Mtn	MT	Developmentally Disabled Services Day Training Agency	$0	$3.7M
Great Falls Sl, LLC	MT	Assisted Living Facility	$0	$3M
Cmsc, LLC	MT	General Acute Care Hospital	$0	$2.6M

Benefis Hospitals, Inc. — Billing Profile & Reimbursement Data

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Benefis Hospitals, Inc. — 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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