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.

Sanford Clinic (NPI 1912932997)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sanford Clinic
Address	1210 W 18th St
City	Sioux Falls
State	SD
ZIP	57104
Taxonomy	Diagnostic Radiology Physician
NPI Enumerated	July 11, 2006

Payer Source	Total Paid
Medicaid	$6M
Medicare	$0

Sanford Clinic presents an effectively single‑payer billing profile in this dataset: there is no Medicare billing on file and all reported federal payer revenue is Medicaid, totaling $6M. The lack of Medicare activity limits cross‑payer comparison and suggests the provider’s recorded footprint in these data is dominated by Medicaid flows.

Revenue is concentrated in a small set of diagnostic imaging codes: the top three Medicaid codes (74177, 70450, 70553) account for 35.6% of the provider’s total Medicaid revenue. Those three contributors are 74177 at 15.9%, 70450 at 9.9%, and 70553 at 9.8%, indicating a small number of high‑revenue modalities drive a large share of Medicaid receipts.

The code mix shows Sanford Clinic operates as a high‑volume, multi‑modality radiology provider focused on cross‑sectional and emergency imaging: top revenue codes include CT abdomen/pelvis with contrast (74177), CT head without contrast (70450), and MRI brain sequences (70553). Combined with substantial CTA chest (71275) and multiple MRI spine codes, the portfolio indicates capacity for both routine and advanced diagnostic imaging rather than a narrow specialty.

Operational throughput is a major component of the business model: several low‑reimbursement, high‑volume radiography codes dominate claim counts — for example 71045 (49.2K claims, $7 avg paid/claim) and 71046 (34.9K claims, $9 avg paid/claim) — which together contribute meaningful Medicaid revenue despite low per‑claim payments. This pattern is consistent with an imaging organization that captures large outpatient and inpatient film volumes alongside higher‑priced cross‑sectional studies.

Sanford Clinic is a dominant statewide competitor for many imaging services: it ranks #1 in‑state and at the 100th percentile for core modalities such as 74177 (rank #1 of 19), 70450 (rank #1 of 21), 71275 (rank #1 of 10), and numerous ultrasound and MRI codes. Those rank and percentile indicators point to market leadership within South Dakota across multiple modalities rather than modest or niche participation.

Multiple codes are flagged as statistical outliers or notably above typical state volume, reinforcing the provider’s unusually high activity levels for certain services: 71045 and 71046 are labeled “extreme outlier,” while codes like 74177, 71275, 76705, and 76770 are described as “notably above typical state volume.” These descriptors suggest volumes that materially exceed state norms for routine radiography, CT, and ultrasound services.

Sanford Clinic also provides some specialized image‑guided and procedural services in addition to diagnostic imaging: 49452 (gastrojejunostomy tube replacement) generated $155.6K in Medicaid revenue and ranks #1 of 1 provider in‑state, and 49083 (image‑guided paracentesis) appears with substantial per‑claim payments and programmatic volume. The presence of these codes indicates capability for interventional radiology procedures and bedside image‑guided interventions alongside diagnostic work.

The provider’s NPI has been enumerated since 2006-07-11 (~20 years ago), indicating long tenure in the market; combined with the sustained, dominant Medicaid volumes reported here, that suggests an established imaging hub in Sioux Falls. However, because there is no Medicare billing on file, conclusions about overall payer diversification or cross‑population strategy are limited to the Medicaid perspective shown in these data.

Medicaid: Complete Services Breakdown

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

84 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	11,950	$70	$836.2K
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.	12,660	$40	$519.2K
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	2,430	$210	$518.2K
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…	3,760	$130	$474K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	49,200	$10	$344.4K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	34,930	$10	$314.4K
70551	The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam.	2,790	$110	$306.4K
74018	Report this code for one X–ray view of the structures and organs in the abdomen to diagnose certain abdominal problems.	19,140	$10	$172.3K
49452	Under fluoroscopic guidance, the provider replaces the existing gastrojejunostomy tube through the skin. Providers may exchange the tube when the existing tube becomes dislodged or no longer…	270	$590	$155.6K
72148	In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the lumbar spinal canal and contents without using contrast.	1,340	$110	$151.8K

Showing 1–10 of 84

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

Sanford Clinic — 19 of 25 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

84 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	1	10	1,550	$190	$259.7K
49452	Under fluoroscopic guidance, the provider replaces the existing gastrojejunostomy tube through the skin. Providers may exchange the tube when the existing tube becomes dislodged or no longer…	1	10	270	$590	$155.5K
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.	1	20	100	$70	$140K
49083	In this procedure, the provider withdraws an abnormal buildup of fluid from the abdominal cavity to relieve pressure and pain or to obtain a sample to submit to a laboratory for analysis. He…	3	10	590	$160	$123.4K
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…	1	10	50	$120	$119.9K
78815	PET and CT scans are both standard imaging tools that allow doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen.…	3	10	50	$960	$117.6K
70551	The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam.	1	10	1,180	$100	$112.1K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	20	20	260	$40	$90.3K
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.	1	20	140	$40	$78.1K
93975	The provider performs a complete study of the abdominal, pelvic, scrotal, and or retroperitoneal organs using duplex ultrasound. He performs the procedure to examine the vascular supply to the organs…	1	10	1,240	$60	$64.4K

Showing 1–10 of 84

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Sanford Medical Center	SD	General Acute Care Hospital	$0	$24.4M
Sanford Medical Center	SD	Clinical Medical Laboratory	$1.8M	$18M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Sanford Health Network	MN	Rural Acute Care Hospital	$0	$7.6M
Sanford Health Network	IA	Family Medicine Physician	$0	$6.6M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M
Sanford Health Network	SD	General Acute Care Hospital	$0	$4.4M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lutheran Social Services Of Sd	SD	Psychiatric Residential Treatment Facility	$0	$15.7M
Iwe Inc.	SD	In Home Supportive Care Agency	$0	$15M
City Of Sioux Falls	SD	Federally Qualified Health Center (FQHC)	$0	$8.6M
South Dakota Home Care, Inc.	SD	Respite Care	$0	$8.6M
Paramedics Logistics South Dakota LLC	SD	Land Ambulance	$1.9M	$3.6M
Sanford Healthcare Accessories, LLC	SD	Durable Medical Equipment & Medical Supplies	$0	$3.1M
Behavior Care Specialists, Inc	SD	Behavior Analyst	$0	$2.9M
Asana Integrated Medical Group PC	SD	Psychiatry Physician	$0	$2.5M
Rehabilitation Medical Supply	SD	Durable Medical Equipment & Medical Supplies	$0	$2.1M
Children's Care Hospital And School	SD	Rehabilitation Clinic/Center	$0	$2M

Sanford Clinic — Billing Profile & Reimbursement Data

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Sanford Clinic — 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