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

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

Ssm Cardinal Glennon Childrens Hospital (NPI 1174577670)

Ssm Cardinal Glennon Childrens Hospital is a pediatrics physician provider located in O Fallon, Illinois. This profile covers 0 Medicare and 71 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	Ssm Cardinal Glennon Childrens Hospital
Address	1 Saint Elizabeth Blvd
City	O Fallon
State	IL
ZIP	62269
Taxonomy	Pediatrics Physician
NPI Enumerated	May 19, 2006

Payer Source	Total Paid
Medicaid	$5.4M
Medicare	$0

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

71 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	21,520	$70	$1.4M
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…	16,240	$70	$1.1M
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…	5,480	$90	$482.1K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	11,100	$30	$355.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,760	$90	$338K
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…	3,950	$80	$327.6K
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…	3,210	$90	$289K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,420	$90	$131K
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…	960	$130	$128.1K
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.	1,000	$120	$116K

Showing 1–10 of 71

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Illinois Distribution

Ssm Cardinal Glennon Childrens Hospital — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Illinois

Full comparison — all codes billed, vs. Illinois median

71 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	1,231	2,920	770	$60	$75.8K
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.	233	880	570	$60	$62.9K
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…	898	14,680	300	$50	$48.7K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	285	320	290	$50	$48K
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…	275	610	820	$40	$46.6K
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…	42	1,380	370	$40	$46.2K
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…	67	1,270	370	$40	$40.8K
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…	214	14,190	280	$20	$38.9K
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.	3	2,840	500	$40	$37.3K
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	114	210	160	$90	$35.2K

Showing 1–10 of 71

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ssm Cardinal Glennon Children's Hospital	MO	Children's Hospital	$0	$52.6M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$50.1M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$27.7M
Ssm Medical Group, Inc.	MO	Multi-Specialty Clinic/Center	$0	$19.4M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$12.4M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$8.9M
Ssm Health Care St. Louis	MO	General Acute Care Hospital	$0	$7.7M
Rotimi Johnson	IL	Vascular & Interventional Radiology Physician	$624.3K	$1.1K
Shamseldeen Mahmoud	MO	Neuroradiology Physician	$109.5K	$474K
Paul Hinton	MO	Internal Medicine Physician	$369.6K	$166.4K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southern Illinois Healthcare Foundation Inc	IL	Federally Qualified Health Center (FQHC)	$0	$7.9M
John Visconti	IL	Medical Oncology Physician	$2.8M	$149.1K
Bassam Maalouf	IL	Hematology & Oncology Physician	$1.8M	$770.9K
Brett Herzog	IL	Medical Oncology Physician	$1.9M	$40.7K
Justin Floyd	IL	Medical Oncology Physician	$1.3M	$336.2K
Mark Walshauser	IL	Hematology & Oncology Physician	$437.5K	$395.5K
O'fallon Surgical Center, LLC	IL	Ambulatory Surgical Clinic/Center	$793.7K	$0
Scott Roustio	IL	Emergency Medicine Physician	$83.8K	$625.5K
Michael Stock	IL	Ophthalmology Physician	$669.2K	$0
Raghav Govindarajan	IL	Neuromuscular Medicine (Psychiatry & Neurology) Physician	$377.7K	$282.1K

Ssm Cardinal Glennon Childrens Hospital — 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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