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

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

Tooele Clinic Corp (NPI 1073512364)

Tooele Clinic Corp is a family medicine physician provider located in Tooele, Utah. This profile covers 0 Medicare and 57 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	Tooele Clinic Corp
Address	1887 Aaron Dr Ste B
City	Tooele
State	UT
ZIP	84074
Taxonomy	Family Medicine Physician
NPI Enumerated	July 19, 2005

Payer Source	Total Paid
Medicaid	$1.3M
Medicare	$0

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

57 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	10,290	$50	$535.2K
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…	2,690	$90	$250.1K
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…	3,970	$50	$214.4K
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…	1,180	$100	$121.3K
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…	860	$40	$34.2K
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…	430	$50	$19.5K
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…	330	$60	$19.4K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	4,090	$1	$16.4K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	170	$90	$15.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	180	$80	$14.7K

Showing 1–10 of 57

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Tooele Clinic Corp — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

57 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	28	240	220	$50	$145.2K
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…	103	1,340	200	$80	$144K
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…	37	1,360	190	$70	$125K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	58	90	460	$50	$115K
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…	52	200	240	$90	$85.8K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	114	160	250	$50	$76.9K
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…	20	220	200	$80	$74K
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…	31	190	150	$80	$58.1K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	39	90	140	$90	$56K
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…	69	270	80	$100	$41.6K

Showing 1–10 of 57

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
University Of Utah Adult Services	UT	Emergency Medicine Physician	$0	$6.9M
University Of Utah Adult Services	UT	Diagnostic Radiology Physician	$0	$4M
University Of Utah Adult Services	UT	Internal Medicine Physician	$0	$3.5M
After Hours Medical LLC	UT	Urgent Care Clinic/Center	$0	$3.2M
University Of Utah Adult Services	UT	Ophthalmology Physician	$0	$3.1M
University Of Utah Adult Services	UT	Anesthesiology Physician	$0	$3M
Christopher Komanski	NC	Ophthalmology Physician	$2.3M	$0
Cecinio Ronquillo	CO	Ophthalmology Physician	$2.1M	$0
Peggy Chan	NY	Nuclear Medicine Physician	$1.7M	$56.8K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Skull Valley Health Care	UT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$25.8M
Tooele Hospital Corporation	UT	General Acute Care Hospital	$0	$11.6M
Nat-su Behavioral Health LLC	UT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$6.3M
Skull Valley Health Clinic	UT	Clinic/Center	$0	$4.5M
Ambulance Services Of Tooele, LLC	UT	Land Ambulance	$372.1K	$3.4M
Goshute Health Care LLC	UT	Clinic/Center	$0	$2.9M
Patrick Green Md PLLC	UT	Primary Care Clinic/Center	$0	$1.8M
Tooele County School District	UT	Local Education Agency (LEA)	$0	$1.4M
Jim J. Gould, Md PC	UT	Clinic/Center	$0	$1.2M
Nat-su Health Care LLC	UT	Clinic/Center	$0	$1.1M

Tooele Clinic Corp — Billing Profile & Reimbursement Data

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Tooele Clinic Corp — 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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