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.

Knox Community Hospital (NPI 1295761963)

Knox Community Hospital is a general acute care hospital provider located in Mount Vernon, Ohio. This profile covers 0 Medicare and 338 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	Knox Community Hospital
Address	1330 Coshocton Ave
City	Mount Vernon
State	OH
ZIP	43050
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 24, 2006

Payer Source	Total Paid
Medicaid	$29.3M
Medicare	$0

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

338 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…	62,740	$80	$5.1M
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,…	64,330	$80	$4.9M
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.	22,710	$120	$2.8M
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.	20,040	$120	$2.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	46,400	$30	$1.4M
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.	10,150	$120	$1.2M
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	3,890	$190	$739.1K
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.	1,990	$300	$593.6K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	7,260	$80	$580.5K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	8,760	$60	$525.5K

Showing 1–10 of 338

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

Knox Community Hospital — 3 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

338 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	22	150	4,030	$100	$5.9M
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.	140	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.	124	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.	145	580	510	$100	$1.3M
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.	114	290	1,380	$90	$635.2K
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.	112	280	1,110	$110	$605.7K
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.	160	230	2,200	$100	$530.1K
G0378	Hospital observation service, per hour	114	160	2,840	$80	$529.2K
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.	156	180	1,760	$140	$494.1K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	153	340	2,260	$30	$398.2K

Showing 1–10 of 338

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ohiohealth Corporation	OH	Family Medicine Physician	$0	$89.1M
Marion Area Physicians LLC	OH	Internal Medicine Physician	$0	$15.7M
Balaji Shanmugam	FL	Interventional Cardiology Physician	$257.1K	$0
Jed Henry	OH	Urology Physician	$256.3K	$0
Shailesh Patel	OH	Clinical Cardiac Electrophysiology Physician	$226.8K	$0
David Brown	OH	Urology Physician	$216K	$0
Frederick Carroll	OH	Internal Medicine Physician	$188.8K	$0
Mary Breckenridge	OH	Cardiovascular Disease Physician	$158.5K	$0
Deborah Reeder	OH	Ophthalmology Physician	$148.5K	$270
Samuel Anderson	OH	Endocrinology, Diabetes & Metabolism Physician	$116.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Riverside Recovery Services LLC	OH	Community/Behavioral Health Agency	$0	$28.7M
Peoplefirst Homecare & Hospice Of Ohio, LLC	OH	Community Based Hospice Care Agency	$0	$19.9M
City Of Mount Vernon City Auditor	OH	Land Ambulance	$452.9K	$810.8K
Michael Fracassa	OH	Podiatrist	$101.1K	$0
Gangaram Rasa	OH	Cardiovascular Disease Physician	$99.1K	$960
Gregory Johnson	OH	Psychologist	$74K	$0
Michael Heuman	OH	Surgery Physician	$66K	$0
Christopher Hetrick	OH	Otolaryngology Physician	$65.3K	$0
Kelsey Durbin	OH	Ophthalmology Physician	$60.9K	$0
Sadie Bailey	OH	Occupational Therapist	$49.8K	$0

Knox Community Hospital — Billing Profile & Reimbursement Data

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Knox Community 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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