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

Why is the Medicaid comparison limited to Idaho 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. Idaho (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 Josephs Ear Nose And Throat Clinic PLLC (NPI 1952355539)

St Josephs Ear Nose And Throat Clinic PLLC is a specialist provider located in Post Falls, Idaho. This profile covers 0 Medicare and 16 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 Josephs Ear Nose And Throat Clinic PLLC
Address	849 N Syringa St
City	Post Falls
State	ID
ZIP	83854
Taxonomy	Specialist
NPI Enumerated	May 19, 2006

Payer Source	Total Paid
Medicaid	$515.2K
Medicare	$0

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99204	The provider sees a new 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 provider…	1,120	$120	$138.4K
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…	2,240	$60	$125.5K
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…	1,110	$80	$88.9K
99203	The provider sees a new 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 provider…	770	$80	$64.7K
92567	In this procedure, the provider measures the functioning of the middle ear by varying the pressure of air presented to the ear to identify the reason for hearing loss.	3,510	$10	$38.6K
92555	The provider measures a patient’s speech reception/awareness threshold (the lowest volume at which the patient can recognize speech).	760	$20	$14.4K
92557	The provider assesses a patient’s hearing with a series of tones at varying intensities to identify the softest level at which the patient can hear. He also measures the patient’s ability to…	440	$30	$11.9K
92587	Code 92587 is in the Medicine/Special Otorhinolaryngologic Services Section. It involves special procedures of the ears/nose/throat. This code is for screening purposes with interpretation and…	660	$20	$11.9K
95117	The provider injects the patient with allergenic extracts to desensitize the patient to the allergen; the patient receives 2 or more injections at a single visit.	1,570	$10	$11K
92579	The provider performs a battery of tests to evaluate hearing loss in infants and toddlers. He uses sound sources to evaluate the auditory response, with reinforcement by animated toys.	90	$40	$3.3K

Showing 1–10 of 16

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

St Josephs Ear Nose And Throat Clinic PLLC — 1 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

16 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	6	10	560	$160	$215.7K
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…	203	670	740	$40	$193.6K
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…	240	620	560	$60	$191.8K
99203	The provider sees a new 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 provider…	39	220	90	$80	$51.4K
95117	The provider injects the patient with allergenic extracts to desensitize the patient to the allergen; the patient receives 2 or more injections at a single visit.	7	10	2,060	$10	$50.6K
99204	The provider sees a new 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 provider…	15	180	70	$110	$45.6K
92587	Code 92587 is in the Medicine/Special Otorhinolaryngologic Services Section. It involves special procedures of the ears/nose/throat. This code is for screening purposes with interpretation and…	3	10	420	$10	$18.7K
92552	The provider assesses a patient’s hearing with a series of tones at varying intensities to identify the lowest threshold at which the patient can hear.	7	10	160	$20	$17.6K
92579	The provider performs a battery of tests to evaluate hearing loss in infants and toddlers. He uses sound sources to evaluate the auditory response, with reinforcement by animated toys.	4	10	90	$40	$13.6K
92567	In this procedure, the provider measures the functioning of the middle ear by varying the pressure of air presented to the ear to identify the reason for hearing loss.	3	20	200	$10	$12.9K

Showing 1–10 of 16

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thomas Detar	ID	Otolaryngology Physician	$88.9K	$0
Michael Gilbert	ID	Otolaryngology Physician	$73.5K	$0
Philip Gardner	ID	Otolaryngology Physician	$63.7K	$0
Chad Mccormick	ID	Otolaryngology Physician	$46.5K	$0
Anne Sobba-higley	WA	Otolaryngology Physician	$37.2K	$0
Mallory Bruner	ID	Audiologist	$11K	$0
Marisa Ryan	ID	Audiologist	$9.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dirne Health Centers, Inc.	ID	Federally Qualified Health Center (FQHC)	$0	$6.3M
Kootenai County	ID	Local Education Agency (LEA)	$0	$5.2M
Learning Garden Developmental Preschool	ID	Developmentally Disabled Services Day Training Agency	$0	$3.1M
Danko Martincic	ID	Hematology & Oncology Physician	$2.6M	$0
Aaging Better In-home Care, LLC	ID	Home Health Agency	$0	$2.4M
Little Smiles Pediatric Dentistry PC	ID	Pediatric Dentistry	$0	$2.2M
North Idaho Day Surgery LLC	ID	General Acute Care Hospital	$0	$1.2M
Pleasant View Surgery Center, LLC	ID	Ambulatory Surgical Clinic/Center	$1M	$0
Corbin Jacobs	ID	Radiation Oncology Physician	$915.1K	$0
Tandy Therapy LLC	ID	Speech-Language Pathologist	$0	$780.1K

St Josephs Ear Nose And Throat Clinic PLLC — Billing Profile & Reimbursement Data

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St Josephs Ear Nose And Throat Clinic PLLC — 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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