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.

The Metrohealth System (NPI 1053353896)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Metrohealth System
Address	2500 Metrohealth Dr
City	Cleveland
State	OH
ZIP	44109
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	June 12, 2006

Payer Source	Total Paid
Medicaid	$125.4M
Medicare	$0

THE METROHEALTH SYSTEM reports no Medicare billing on file and $125.4M in lifetime Medicaid revenue, making its active revenue footprint effectively single‑payer Medicaid under the available data. The absence of any Medicare claims on file indicates payer concentration toward Medicaid rather than a mixed Medicare/Medicaid operating profile.

Revenue concentration is high: the top three Medicaid codes (99214, 99213, 99285) together account for 55.0% of total Medicaid revenue, with 99214 alone contributing $25.3M (27.1%) and 99213 and 99285 contributing $13.8M (14.8%) and $12.1M (13.0%) respectively. This level of concentration around a small set of E/M and ED codes indicates that ambulatory evaluation/management and emergency care are the principal revenue drivers.

The code mix signals a large, multi‑service operation: very high volumes of office/outpatient established‑patient E/M codes (99214, 99213) alongside high‑acuity emergency department codes (99285, 99284, 99283) and inpatient subsequent care (99232) suggest integrated ambulatory and acute care capacity rather than a narrow specialty clinic. Ancillary service codes with meaningful revenue — including 88305 (surgical pathology), 93010 (ECG), 74177 and 70450 (CT imaging), and 93306 (echocardiography) — further indicate on‑site diagnostic and procedural capabilities supporting both outpatient and hospital workflows.

State competitive standing is dominant for many core codes: 99214 ranks #1 of 4514 providers in‑state (100th percentile; extreme outlier, far above typical state volume), 99213 ranks #5 of 5077 (100th percentile; extreme outlier), and 99285 ranks #8 of 581 (99th percentile; extreme outlier). Multiple other codes show similarly exceptional statewide positions (for example, 93010 ranks #2 of 450 at the 100th percentile; 90791 ranks #3 of 1263 at the 100th percentile), indicating THE METROHEALTH SYSTEM is a major statewide provider for both routine and high‑acuity services.

Several high‑acuity and neonatal codes show concentrated specialty activity: neonatal critical care subsequent care 99469 generates $2.9M and ranks #3 of 13 providers in‑state (83th percentile; typical, unremarkable), while critical care 99291 brings $1.5M and ranks #3 of 262 (99th percentile; extreme outlier, far above typical state volume). These entries suggest the organization manages intensive and neonatal care caseloads in addition to high ED throughput.

Behavioral health and preventive care are material components of the mix: psychiatric evaluation 90791 ($1.6M, ranks #3 of 1263, 100th percentile; extreme outlier) and psychotherapy 90834 ($1.2M, ranks #22 of 1316, 98th percentile; notably above typical) together indicate sizable mental‑health service volume, while well‑child and preventive codes (99392, 99393, 99393/99394 series) each contribute meaningful revenue and rank near the top of state peers (99th percentile or higher).

Operational maturity is long established: the NPI was enumerated on 2006‑06‑12 (~20 years ago), which aligns with the large lifetime Medicaid volumes and extensive code breadth observed across outpatient, emergency, inpatient, neonatal, imaging, pathology, and behavioral health services. This tenure supports interpretation of the provider as an entrenched multispecialty system in the state Medicaid market.

While the Medicaid profile shows breadth and dominance across many service lines, the complete lack of Medicare billing on file is notable; payers and network managers should treat THE METROHEALTH SYSTEM as effectively Medicaid‑heavy for contracting and utilization analyses based on the available records rather than as a balanced Medicare/Medicaid provider.

Medicaid: Complete Services Breakdown

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

447 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	766,130	$30	$25.3M
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…	628,800	$20	$13.8M
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.	164,150	$70	$12.1M
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.	163,360	$50	$8.8M
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.	114,350	$30	$3.8M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	10,670	$270	$2.9M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	116,380	$20	$2.4M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	43,340	$50	$2M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	54,250	$40	$1.9M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	52,720	$30	$1.6M

Showing 1–10 of 447

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

The Metrohealth System — 22 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

447 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…	469	610	1,350	$150	$1.9M
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.	20	480	4,510	$90	$1.8M
H2019	Therapeutic behavioral services, per 15 minutes	432	840	240	$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.	13	660	460	$90	$1.5M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	3	10	1,020	$280	$1.3M
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.	8	580	510	$100	$1.3M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	5	10	480	$290	$1.2M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	5	20	4,730	$90	$818.4K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	3	20	1,320	$90	$727.9K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	33	40	100	$850	$680.6K

Showing 1–10 of 447

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Metrohealth System	OH	General Acute Care Hospital	$0	$574.3M
The Metrohealth System	OH	Air Ambulance	$0	$27.3M
The Metrohealth System	OH	Dentist	$0	$7.8M
Syed Akbar	IL	Diagnostic Radiology Physician	$280.8K	$223.7K
Alex Yuan	OH	Ophthalmology Physician	$471.3K	$0
Steven Benedict	OH	Neurology Physician	$347.4K	$0
Chad Marcantonio	OH	Ophthalmology Physician	$310.9K	$0
Andrea Natale	TX	Clinical Cardiac Electrophysiology Physician	$309.4K	$0
Edward Barton	CA	Neurology Physician	$260.1K	$0
The Metrohealth System	OH	Community/Retail Pharmacy	$242K	$50

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ohio Renal Care Group, LLC	OH	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$7M
Raj Vallabhaneni	OH	Interventional Cardiology Physician	$187.7K	$0
Stephen Scull	OH	Emergency Medicine Physician	$83.8K	$42K
Bryan Canterbury	OH	Emergency Medicine Physician	$106.8K	$0
Ann Rivera	OH	Diagnostic Radiology Physician	$73.3K	$8.1K
Aleksandr Rovner	OH	Cardiovascular Disease Physician	$79.7K	$30
Kevin Casebolt	OH	Emergency Medicine Physician	$77.3K	$0
Aurelia Cheng	OH	Emergency Medicine Physician	$75.2K	$0
Laila Shiekh Sroujieh	OH	Internal Medicine Physician	$73.7K	$0
Sean Nagel	OH	Neurological Surgery Physician	$72.2K	$0

The Metrohealth System — Billing Profile & Reimbursement Data

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The Metrohealth System — 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