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.

Licking Memorial Hospital (NPI 1568446755)

Key Findings

Field	Value
Entity Type	Organization
Organization	Licking Memorial Hospital
Address	1320 W Main St
City	Newark
State	OH
ZIP	43055
Taxonomy	General Acute Care Hospital
NPI Enumerated	December 1, 2005

Payer Source	Total Paid
Medicaid	$55.9M
Medicare	$0

LICKING MEMORIAL HOSPITAL reports no Medicare billing on file while recording $55.9M in lifetime Medicaid revenue, effectively making Medicaid the sole payer represented in this dataset for this provider. The hospital’s NPI was enumerated on 2005-12-01 (~21 years ago), indicating long-standing participation in the public payer market captured here.

Revenue is highly concentrated: the precomputed top three Medicaid codes (99212, 96361, 99284) account for 46.7% of the provider’s total Medicaid revenue. The single largest line, 99212, contributes $10.5M (23.3% of Medicaid revenue), highlighting dependence on a small set of services for nearly half of Medicaid receipts.

The code mix points to a combined emergency and high-volume outpatient operation. High-volume ED evaluation-and-management codes appear throughout the top list (99284 with 34.9K claims and $4.8M revenue; 99283 and 99285 also present), and the presence of frequent lower-complexity office/clinic codes (99212, 99211, 99213) signals sizable outpatient clinic throughput tied to the hospital.

Infusion and dehydration treatment are a notable service line: 96361 shows 18.4K claims for $5.7M (12.7% of Medicaid revenue) and related infusion codes 96360 and 96365 are also in the top claims. These volumes, together with observation-level billing (G0378), indicate substantial use of IV fluid/infusion care and short-term observation for acute medical presentations.

LICKING MEMORIAL is an outlier statewide for routine outpatient exam volume: 99212 (89.6K claims, $10.5M) ranks #4 of 1608 providers in-state and is labeled an "extreme outlier," and 99211 (37K claims, $4.5M) ranks #10 of 703 providers (99th percentile; notably above typical). These rankings identify the hospital as a dominant provider of low-to-moderate complexity outpatient visits in Ohio Medicaid.

Imaging and laboratory services form a steady secondary revenue stream: CT head 70450 ($1.2M), CT abdomen/pelvis 74177 ($1.1M) and 74176 ($481.4K), along with high-claim lab panels 80053 (29.4K claims, $500.6K) and 80048 (46K claims, $367.9K), appear in the top codes. These entries show an on-site diagnostic footprint supporting both ED and outpatient care rather than low-volume outsourced imaging or lab activity.

The hospital shows unusually high state-level volumes for several interventional outpatient procedures: 62323 ($499.6K) ranks #4 of 115 providers (97th percentile; notably above typical), and 27096 ($355.9K) ranks #3 of 51 providers (96th percentile; notably above typical). Those ranks indicate the facility is a significant regional provider for image-guided spinal and sacroiliac joint procedures relative to peers.

Outside of a few standout codes, many top Medicaid codes (several ED E/M levels, CTs, labs, and infusion codes) report rank percentiles clustered in the 70th–88th range and are described as typical or unremarkable for the state. In sum, LICKING MEMORIAL appears to be a long-tenured hospital with concentrated Medicaid revenue driven by very high volumes of low-to-moderate complexity outpatient visits, substantial ED throughput and infusion care, and notable regional standing for select image-guided procedures.

Medicaid: Complete Services Breakdown

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

478 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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,…	89,560	$120	$10.5M
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.	18,430	$310	$5.7M
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.	34,850	$140	$4.8M
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.	37,940	$120	$4.5M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	37,000	$120	$4.5M
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.	16,590	$150	$2.5M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	8,760	$170	$1.4M
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.	9,590	$120	$1.2M
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.	4,480	$260	$1.2M
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.	4,200	$270	$1.1M

Showing 1–10 of 478

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

Licking Memorial Hospital — 4 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

478 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	108	150	4,030	$100	$5.9M
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	3	10	510	$320	$4M
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.	21	170	4,660	$300	$2.6M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	162	610	1,350	$150	$1.9M
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.	78	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.	93	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.	107	580	510	$100	$1.3M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	44	140	1,130	$90	$1.1M
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…	32	50	310	$110	$817.2K
80081	The lab analyst performs an obstetric panel; this panel must include tests for a complete blood count with differential, a hepatitis B surface antigen test, a single–result test for HIV–1 antigens…	15	20	480	$50	$671.8K

Showing 1–10 of 478

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hospice Of Central Ohio	OH	Community Based Hospice Care Agency	$0	$28M
Licking Memorial Health Professionals	OH	Family Medicine Physician	$0	$23.9M
Behavioral Healthcare Partners Of Central Ohio Inc	OH	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$14M
City Of Newark	OH	Land Ambulance	$505.9K	$2M
Courtesy Ambulance, Inc.	OH	Land Ambulance	$343.3K	$1.8M
Licking County	OH	Public Health or Welfare Agency	$31.4K	$524.4K
Chuck Cho	OH	Radiation Oncology Physician	$314.9K	$0
Thomas Petryk	OH	Family Medicine Physician	$274.7K	$0
Mark Law	OH	Ophthalmology Physician	$258.6K	$490
Shahin Shahinfar	OH	Ophthalmology Physician	$254.9K	$0

Licking Memorial 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