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

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

Children's Hospital & Medical Center (NPI 1962866418)

Field	Value
Entity Type	Organization
Organization	Children's Hospital & Medical Center
Address	110 N 175th St Ste 1600
City	Omaha
State	NE
ZIP	68118
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	April 11, 2016

Payer Source	Total Paid
Medicaid	$10M
Medicare	$0

Key Findings

CHILDREN'S HOSPITAL & MEDICAL CENTER is registered as a Multi-Specialty Clinic/Center and was enumerated on 2016-04-11 (~10 years ago). Its claims profile shows no Medicare billing on file and $10M in lifetime Medicaid revenue, making this effectively a Medicaid-centric provider in the available data rather than a dual‑payer operation.

Revenue is extremely concentrated: the precomputed top three Medicaid codes account for 96.6% of the provider's Medicaid revenue. The single largest contributor is 41899, which alone represents $8.5M (84.5% of Medicaid revenue), followed by 69436 ($1.1M, 11.1%) and J3490 ($105.3K, 1.0%).

The code mix points to a pediatric procedural and dental service orientation. 41899 is a catch‑all dental/teeth procedure code and dominates revenue, while 69436 (tympanostomy with tube insertion under general anesthesia) signals routine pediatric ENT surgery; the presence of many drug administration and infusion codes (for example J3490, J7120) is consistent with an ambulatory surgical or hospital outpatient practice that supports these procedures.

On competitive standing for the dominant dental code, the provider ranks #3 of 17 providers in-state (88th percentile; typical, unremarkable volume for this code), indicating it is among the higher‑revenue state providers for 41899 even though that activity is described as typical within the dataset. Given that 41899 accounts for $8.5M (84.5% of Medicaid revenue), this single code makes the provider a material state‑level participant in dental procedure billing.

For tympanostomy procedures (69436) the provider ranks #6 of 19 providers in-state (72th percentile; typical, unremarkable volume for this code), which positions it as a mid‑level state participant for pediatric ENT tube placements rather than a dominant provider in that service line. Despite modest rank, 69436 still contributes $1.1M (11.1% of Medicaid revenue) and is the clear secondary revenue driver.

Operational volume is high for several ancillary or drug administration codes but these generate small portions of revenue individually. For example, J3490 shows 11.7K claims with $9 avg paid/claim and $105.3K revenue (1.0% of Medicaid revenue), 87426 has 1.7K claims and $64.8K revenue (0.6%), and J7120 has 4.2K claims and $62.4K revenue (0.6%), indicating many low‑paid, high‑count services that support the principal procedural business lines.

There are billing items that appear as paid claims but report $0 revenue in the dataset, which may reflect zero‑paid claims, pass‑through reporting, or administrative artifacts. Examples include J2272 (131 claims, $0 avg paid/claim, $0 revenue) and L8613 (32 claims, $0 avg paid/claim, $0 revenue); these warrant review if reconciling encounter volumes to paid dollars.

For payer strategy and utilization review, the provider should be treated as a Medicaid‑focused pediatric surgical/dental center with concentrated reimbursement risk around a very small set of codes (top three = 96.6% of Medicaid revenue). Contracting, prior authorization, and utilization management efforts will have the most impact if they target 41899 and 69436 while monitoring the high‑volume, low‑payment ancillary codes for operational cost and throughput implications.

Medicaid: Complete Services Breakdown

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

17 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	3,460	$2,450	$8.5M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	580	$1,910	$1.1M
J3490	Unclassified drugs	11,700	$10	$105.3K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	1,660	$40	$64.8K
J7120	Ringers lactate infusion, up to 1000 cc	4,160	$20	$62.4K
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	10	$3,020	$36.3K
C9803	Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source	1,720	$20	$32.6K
J2704	Injection, propofol, 10 mg	3,530	$10	$24.7K
J1100	Injection, dexamethasone sodium phosphate, 1 mg	4,010	$10	$24.1K
J1885	Injection, ketorolac tromethamine, per 15 mg	3,380	$10	$23.7K

Showing 1–10 of 17

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

Children's Hospital & Medical Center — 0 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

17 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	3	20	460	$1,260	$1.8M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	6	20	240	$900	$448.5K
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	6	10	20	$1,740	$73.3K
J3490	Unclassified drugs	16	80	1,040	$1	$36.9K
C9803	Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source	5	30	280	$20	$32.5K
70310	The provider takes X–rays of some of the teeth in the mouth but not all.	2	10	1,400	$20	$27.4K
J7120	Ringers lactate infusion, up to 1000 cc	11	30	1,610	$10	$24.7K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	11	90	180	$30	$21.1K
J2405	Injection, ondansetron hydrochloride, per 1 mg	12	40	1,820	$1	$13.3K
J2704	Injection, propofol, 10 mg	8	30	930	$1	$10.7K

Showing 1–10 of 17

Related Providers

Other providers that share a Tax Identification Number (TIN) with Children's Hospital & Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital & Medical Center	NE	Children's Hospital	$0	$89.8M
Nebraska Pediatric Practice, Inc	NE	Pediatrics Physician	$0	$29M
Children's Hospital	NE	Pediatric Emergency Medicine (Pediatrics) Physician	$0	$8.4M
Children's Specialty Physician Billing - Behavioral Health	NE	Psychologist	$0	$1.9M
Children's Rehab - Occupational Therapy	NE	Pediatric Occupational Therapist	$0	$388.1K

Nearby Providers

Other providers in the same ZIP code as Children's Hospital & Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
David Vogel	NE	Vascular Surgery Physician	$1.5M	$0
United Vascular Of Omaha LLC	NE	Ambulatory Surgical Clinic/Center	$865.1K	$0
Thomas Franco	NE	Physical Medicine & Rehabilitation Physician	$526.6K	$0
Michael Shnayder	NE	Oral and Maxillofacial Surgery (Dentist)	$0	$411.6K
Scott Debates	NE	Dermatology Physician	$393.1K	$0
Paradigm Inc	NE	Community/Behavioral Health Agency	$0	$322.5K
Methodist Endoscopy Center LLC	NE	Ambulatory Surgical Clinic/Center	$305.5K	$0
James Maliszewski	NE	Internal Medicine Physician	$300.6K	$0
Tomas Huerta	NE	MOHS-Micrographic Surgery Physician	$297.3K	$0
Deirdre Stolmeier	NE	Dermatology Physician	$288.7K	$0

Children's Hospital & Medical Center — 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