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.

Toledo Clinic Incorporated (NPI 1144217894)

Toledo Clinic Incorporated is a surgery physician provider located in Toledo, Ohio. This profile covers 0 Medicare and 255 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	Toledo Clinic Incorporated
Address	4235 Secor Rd
City	Toledo
State	OH
ZIP	43623
Taxonomy	Surgery Physician
NPI Enumerated	September 28, 2005

Payer Source	Total Paid
Medicaid	$15.9M
Medicare	$0

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

255 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…	118,800	$40	$5M
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…	86,380	$30	$2.6M
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…	63,880	$20	$1M
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…	42,610	$20	$894.9K
99308	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider…	48,470	$20	$824K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	6,920	$80	$540K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	8,590	$50	$463.6K
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…	6,120	$40	$257K
J0585	Injection, onabotulinumtoxina, 1 unit	310	$800	$246K
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…	5,120	$40	$225.2K

Showing 1–10 of 255

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

Toledo Clinic Incorporated — 9 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

255 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0585	Injection, onabotulinumtoxina, 1 unit	26	60	250	$730	$707.7K
80050	The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the…	35	50	220	$30	$675.9K
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.	232	280	1,110	$110	$605.7K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	180	180	1,760	$140	$494.1K
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…	36	4,510	500	$60	$377.8K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	67	100	1,000	$120	$357.1K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	206	270	8,700	$10	$353.7K
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…	64	5,080	560	$40	$323.9K
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…	146	430	560	$60	$303.2K
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…	142	480	450	$70	$292.9K

Showing 1–10 of 255

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Toledo Clinic Incorporated	OH	Clinical Medical Laboratory	$2.1M	$2M
Toledo Clinic Incorporated	OH	Clinic/Center	$2.4M	$812.9K
Timothy Kasunic	OH	Hematology & Oncology Physician	$2M	$0
David Kouba	OH	Dermatology Physician	$1.9M	$0
Niraj Shah	OH	Ophthalmology Physician	$1.3M	$0
Shaili Desai	OH	Hematology & Oncology Physician	$1.2M	$0
Richard Phinney	OH	Medical Oncology Physician	$1.2M	$0
Mohammed Abusamieh	OH	Rheumatology Physician	$1.1M	$0
Aaron Pumerantz	OH	Rheumatology Physician	$985.8K	$0
Patrick Gustine	OH	Diagnostic Radiology Physician	$615.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Midwest Recovery Center LLC	OH	Substance Use Disorder Rehabilitation Clinic/Center	$0	$45.6M
Choices Behavioral Health Care	OH	Community/Behavioral Health Agency	$0	$45.2M
Choices Behavioral Health Care	OH	Community/Behavioral Health Agency	$0	$20.7M
Team Recovery Ohio, LLC	OH	Substance Use Disorder Rehabilitation Clinic/Center	$0	$17.1M
Greater Toledo Urgent Cares, LLC.	OH	Emergency Medicine Physician	$0	$10.9M
Mercy Health - St Anne Hospital LLC	OH	General Acute Care Hospital	$0	$10.6M
Toledo Home Healthcare LLC	OH	Home Health Agency	$0	$7.8M
The Pediatric Center, Inc.	OH	Pediatrics Physician	$0	$7.4M
Surgery Center At Regency Park, LLC	OH	Ambulatory Surgical Clinic/Center	$1.1M	$666K
Jonathan Bernstein	OH	Retina Specialist (Ophthalmology) Physician	$1.2M	$0

Toledo Clinic Incorporated — 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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