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

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

Southern Ohio Medical Center (NPI 1053342816)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southern Ohio Medical Center
Address	1805 27th St
City	Portsmouth
State	OH
ZIP	45662
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 6, 2006

Payer Source	Total Paid
Medicaid	$144.9M
Medicare	$0

This provider is effectively a Medicaid-centric hospital: there is no Medicare billing on file while total Medicaid revenue is $144.9M, indicating the organization operates at scale primarily within the Medicaid program and limiting direct cross‑payer comparison on Medicare performance or market reach. The absence of Medicare claims should be taken into account when benchmarking against hospitals that have mixed payer footprints.

Revenue is highly concentrated in a small set of outpatient and E/M services: the top three Medicaid codes (G0463, 99213, 99214) together account for 63.9% of the provider's total Medicaid revenue. Those three codes are G0463 ($38.7M, 34.7%), 99213 ($17.8M, 15.9%), and 99214 ($14.9M, 13.3%), demonstrating dependence on clinic visits and evaluation/management encounters for the majority of Medicaid dollars.

The code mix signals a heavy outpatient/ambulatory clinic orientation: G0463 (387.1K claims, $38.7M) is the single largest revenue driver and, together with very large volumes of 99213 (189.3K claims, $17.8M) and 99214 (136.7K claims, $14.9M), suggests the hospital runs high-throughput outpatient clinics and established-patient office workflows rather than revenue driven by complex inpatient-only procedures. This pattern is consistent with a facility that concentrates on recurring ambulatory care encounters.

Despite the outpatient concentration, emergency and imaging services are meaningful revenue contributors: emergency E/M codes 99284 (48.6K claims, $6M) and 99285 (30.2K claims, $4M) together represent an important ED footprint, and imaging codes such as 70450 (10K claims, $2.5M) and 74177/74176 (6.3K and 4.5K claims, ~$2.1M and $1.5M) confirm active CT capacity supporting acute care. These lines indicate the hospital supports both urgent/emergency throughput and same-day imaging needs for its Medicaid population.

This provider is a statewide outlier on several laboratory and respiratory testing codes, reflecting high-volume test throughput: C9803 (66.9K claims, $2.2M) ranks #1 of 67 providers and is labeled an "extreme outlier," 87635 (64.5K claims, $1.9M) ranks #2 (100th percentile; extreme outlier), and 87502 (56.3K claims, $1.5M) ranks #1 (100th percentile; extreme outlier). Those rankings indicate the hospital played a major role in SARS‑CoV‑2 and respiratory virus specimen collection/testing relative to in-state peers during the measurement period.

For competitive standing within Ohio Medicaid, the hospital is a major statewide player on routine ambulatory E/M: 99213 ranks #24 of 5077 providers (100th percentile; extreme outlier) and 99214 ranks #29 of 4514 providers (99th percentile; extreme outlier), which positions the facility far above typical state volume for established-patient office visits and suggests market leadership for outpatient access among Medicaid beneficiaries. By contrast, G0463 ranks #4 of 151 (98th percentile) but is described in the dataset as a "typical, unremarkable volume for this code," indicating that while the hospital is high-volume among hospitals for hospital outpatient clinic visits, that code’s statewide distribution is variable and context-dependent.

Service mix also highlights sizable ancillary and rehabilitative operations: therapeutic exercise 97110 (36.2K claims, $2.1M; 98th percentile, notably above typical) and wound debridement 11042 (11.2K claims, $1.1M; 99th percentile, extreme outlier) point to established physical therapy and wound-care throughput. High counts for infusion administration codes (96365/96366) and observation hours (G0378) further indicate ongoing outpatient procedural and post‑treatment monitoring capacity.

The provider has a long enrollment history—NPI enumerated 2006-07-06 (~20 years ago)—which, combined with the concentrated Medicaid revenue and high statewide rankings on core outpatient codes, suggests an established regional presence and operational focus on serving the Medicaid population rather than a mixed Medicare/Medicaid footprint. Analysts should interpret utilization and access trends in the context of a single‑payer (Medicaid) dominated revenue base when assessing competitive strategy or network value.

Medicaid: Complete Services Breakdown

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

648 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	387,130	$100	$38.7M
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…	189,290	$90	$17.8M
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…	136,660	$110	$14.9M
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.	48,610	$120	$6M
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.	30,180	$130	$4M
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.	23,320	$110	$2.6M
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.	9,950	$250	$2.5M
C9803	Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source	66,920	$30	$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,…	25,730	$80	$2.2M
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.	6,310	$340	$2.1M

Showing 1–10 of 648

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

Southern Ohio Medical Center — 12 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

648 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	4	150	4,030	$100	$5.9M
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	6	10	510	$320	$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.	49	170	4,660	$300	$2.6M
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.	124	480	4,510	$90	$1.8M
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.	58	660	460	$90	$1.5M
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.	64	580	510	$100	$1.3M
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…	66	140	1,130	$90	$1.1M
G0482	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	41	80	910	$110	$884.9K
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	12	50	310	$110	$817.2K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	68	80	100	$860	$719.1K

Showing 1–10 of 648

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Scioto County Counseling Center, Inc	OH	Addiction (Substance Use Disorder) Counselor	$0	$166.5M
Phoenix Group Home, LLC	OH	Community/Behavioral Health Agency	$0	$98.8M
Mahajan Therapeutics, LLC	OH	Community/Behavioral Health Agency	$0	$33.9M
Scioto County Counseling Center, Inc.	OH	Mental Health Counselor	$0	$27.7M
Amazing Grace Center Inc	OH	Methadone Clinic	$349.1K	$26.2M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Portsmouth Emergency Ambulance Service Inc	OH	Ambulance	$3.6M	$18.7M
Genesis Respiratory Services Inc	OH	Durable Medical Equipment & Medical Supplies	$0	$20.4M
Portsmouth Hospital Corporation	OH	General Acute Care Hospital	$0	$19.7M
Jay Hash LLC	OH	Substance Use Disorder Rehabilitation Clinic/Center	$0	$19.1M

Southern Ohio Medical Center — Billing Profile & Reimbursement Data

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Southern Ohio 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