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.

Dayton Children's Hospital (NPI 1457379448)

Key Findings

Field	Value
Entity Type	Organization
Organization	Dayton Children's Hospital
Address	1 Childrens Plz
City	Dayton
State	OH
ZIP	45404
Taxonomy	Children's Hospital
NPI Enumerated	July 17, 2006

Payer Source	Total Paid
Medicaid	$290.6M
Medicare	$0

DAYTON CHILDREN'S HOSPITAL is effectively a single‑payer operation in the CMS data: it has no Medicare billing on file and records $290.6M in lifetime Medicaid revenue, making Medicaid the sole documented federal payer exposure for this provider. This concentration means Medicaid policy and reimbursement trends will have outsized impact on the provider's topline.

Revenue concentration is highly focused in ambulatory and emergency evaluation-and-management services: the precomputed top‑three Medicaid codes (99214, 99213, 99284) account for 45.9% of total Medicaid revenue. That mix indicates a revenue profile driven primarily by high-volume office/outpatient visits and ED-level E/M care rather than inpatient DRG or specialty imaging lines.

Operationally the provider shows very large ambulatory volumes: 99214 appears on 254.3K claims for $37.9M (16.5% of Medicaid revenue) and 99213 on 275K claims for $37.7M (16.4% of Medicaid revenue), while ED code 99284 is 175.8K claims for $29.9M (13.0% of Medicaid revenue). Together these counts and dollar amounts point to a major pediatric outpatient and emergency department footprint with substantial visit-based throughput.

Competitive standing in-state is dominant for core E/M codes: 99214 ranks #16 of 4514 providers in-state (100th percentile; extreme outlier), 99213 ranks #17 of 5077 (100th percentile; extreme outlier), and 99284 ranks #11 of 655 (98th percentile; extreme outlier). Those ranks characterize the hospital as a top-tier, high-volume provider in Ohio for pediatric ambulatory and ED E/M services.

The hospital also supports sizable procedural pediatric ENT and surgical volume: 69436 (tympanostomy) is 4.5K claims for $8.4M (3.7% of Medicaid revenue) and 42820 (tonsil/adenoid removal <12) is 3.2K claims for $4.6M (2.0% of Medicaid revenue). These procedure-level revenues indicate an established surgical specialty program focused on common pediatric ENT operations.

Rehabilitation, developmental, and ancillary services are material contributors to Medicaid revenue: 92507 (speech/hearing) is 162.1K claims for $17.8M (7.8% of Medicaid revenue) and 97110 (therapeutic exercise) is 53.8K claims for $6.7M (2.9% of Medicaid revenue). High volumes and ranks (92507 ranks #2 of 806, 100th percentile; extreme outlier) suggest integrated therapy and developmental care lines serving a large pediatric caseload.

Public health and observation activity are visible in the code mix: U0004 (SARS‑CoV‑2 testing) is 45.6K claims for $10M (4.3% of Medicaid revenue) and G0378 (hospital observation per hour) is 25.6K claims for $2.3M (1.0% of Medicaid revenue). U0004 ranks #1 of 43 providers in-state (100th percentile; extreme outlier), signaling unusually high COVID testing volume relative to peers during the reporting period.

The provider has longstanding registration and scale: NPI enumeration date is 2006-07-17 (~20 years ago), and combined with $290.6M in Medicaid revenue and multiple top‑percentile ranks, this identifies DAYTON CHILDREN'S HOSPITAL as a long‑established, large pediatric Medicaid provider in Ohio with concentrated exposure to visit‑based Medicaid reimbursement.

Medicaid: Complete Services Breakdown

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

620 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…	254,260	$150	$37.9M
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…	275,000	$140	$37.7M
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.	175,790	$170	$29.9M
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.	159,320	$150	$23.3M
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…	162,110	$110	$17.8M
U0004	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by…	45,560	$220	$10M
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.	48,380	$190	$9M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	4,460	$1,890	$8.4M
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…	53,840	$130	$6.7M
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…	34,360	$160	$5.6M

Showing 1–10 of 620

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

Dayton Children's Hospital — 13 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

620 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	40	170	4,660	$300	$2.6M
81479	Use 81479 to report a molecular pathology procedure that does not have a specific code.	6	10	760	$50	$2M
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.	8	480	4,510	$90	$1.8M
90378	Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial…	8	10	720	$2,350	$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.	11	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.	39	580	510	$100	$1.3M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	4	20	260	$1,470	$1.1M
S0201	Partial hospitalization services, less than 24 hours, per diem	3	10	1,190	$420	$1M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	4	30	520	$820	$994.5K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	7	80	100	$860	$719.1K

Showing 1–10 of 620

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dayton Children's Specialty Physicians, Inc.	OH	Pediatrics Physician	$0	$31.8M
Childrens Emergency Services Inc	OH	Pediatric Emergency Medicine (Emergency Medicine) Physician	$0	$8.7M
Laura Tully	OH	Otolaryngology Physician	$94.6K	$0
David Gooden	OH	Anesthesiology Physician	$19.1K	$0

Dayton Children's Hospital — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References