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.

Southern Orthopedic Associates Sc (NPI 1396792412)

Southern Orthopedic Associates Sc is a orthopaedic surgery physician provider located in Herrin, Illinois. This profile covers 0 Medicare and 54 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	Southern Orthopedic Associates Sc
Address	510 Lincoln Dr
City	Herrin
State	IL
ZIP	62948
Taxonomy	Orthopaedic Surgery Physician
NPI Enumerated	May 27, 2006

Payer Source	Total Paid
Medicaid	$3.2M
Medicare	$0

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

54 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…	31,070	$20	$621.4K
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	4,320	$140	$609.1K
62323	The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)…	2,620	$100	$269.3K
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.	6,880	$40	$254.6K
64635	Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue.	1,200	$180	$219.4K
G0482	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	2,430	$90	$213.8K
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…	6,340	$30	$183.8K
64636	In this add on procedure, the provider destroys the facet joint nerve of a lumbar or sacral spinal segment using neurolytic agents like heat, electric current, or a chemical compound. He makes use of…	1,980	$80	$154.7K
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…	5,190	$20	$119.5K
64493	The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance…	630	$110	$69.3K

Showing 1–10 of 54

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

Southern Orthopedic Associates Sc — 10 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

54 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	8	20	940	$110	$1.1M
G0482	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	5	10	2,430	$70	$286.5K
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.	47	280	1,120	$30	$218.9K
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…	156	1,220	540	$60	$179.4K
64635	Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue.	1	10	500	$140	$72.9K
97161	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	143	200	200	$90	$51.4K
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…	318	14,680	300	$50	$48.7K
97162	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	146	150	150	$80	$47.1K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	95	140	360	$20	$39.7K
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…	105	14,190	280	$20	$38.9K

Showing 1–10 of 54

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
David Lindenberg	CA	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$1.3M	$320
John Ruxer	KY	Pain Medicine Physician	$1M	$274.3K
Tennyson Lee	IL	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$364.8K	$71.3K
Shiraz Patel	KY	Orthopaedic Surgery Physician	$318.9K	$0
Steven Young	IL	Orthopaedic Surgery Physician	$189.8K	$90.7K
James Davis	IL	Orthopaedic Surgery Physician	$225.7K	$23.1K
Frederick Deweese	KY	Orthopaedic Surgery Physician	$235.2K	$0
Brian Kern	KY	Orthopaedic Surgery Physician	$196.2K	$0
Ryan Beck	KY	Orthopaedic Surgery Physician	$180.2K	$0
John Nugent	IL	Physician Assistant	$152.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southern Illinois Medical Services, Nfp	IL	Rural Health Clinic/Center	$0	$9.2M
Southern Illinois Hospital Services	IL	General Acute Care Hospital	$0	$5.4M
Ted Van Acker	IL	Dermatology Physician	$1.4M	$320.7K
Sushilkumar Tibrewala	IL	Gastroenterology Physician	$131.6K	$807K
Mustafa Hindi	IL	Emergency Medicine Physician	$107.8K	$744.8K
Mack Mccain	IL	Gastroenterology Physician	$92.3K	$702.2K
Derek Kenneaster	IL	Dermatology Physician	$229.5K	$343.5K
Terrence Glennon	IL	Physical Medicine & Rehabilitation Physician	$149.4K	$311.3K
Southern Illinois Orthopedic Center,llc	IL	Ambulatory Surgical Clinic/Center	$446.3K	$0
Gerri Dyer	IL	Nurse Practitioner	$175.1K	$109.5K

Southern Orthopedic Associates Sc — Billing Profile & Reimbursement Data

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Southern Orthopedic Associates Sc — 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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