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

Why is the Medicaid comparison limited to California 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. California (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 Monterey County Memorial Hospital (NPI 1811188188)

Southern Monterey County Memorial Hospital is a rural health clinic/center provider located in King City, California. This profile covers 0 Medicare and 103 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 Monterey County Memorial Hospital
Address	210 Canal St
City	King City
State	CA
ZIP	93930
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	August 5, 2007

Payer Source	Total Paid
Medicaid	$30.3M
Medicare	$0

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

103 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	123,170	$200	$24.6M
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…	84,990	$20	$1.4M
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…	26,170	$30	$706.5K
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,…	25,960	$20	$415.3K
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…	7,780	$50	$357.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6,870	$50	$357K
59425	This service is considered a mini global code for the provider who provides only four to six of the patient’s antepartum visits. This can happen when the patient transfers out of the practice prior…	3,730	$80	$309.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4,170	$60	$254.4K
92551	The provider delivers a limited series of tones or sounds to a patient to determine if the patient’s hearing is in an acceptable range to detect hearing problems.	20,180	$10	$242.2K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	1,960	$90	$174.4K

Showing 1–10 of 103

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. California Distribution

Southern Monterey County Memorial Hospital — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — California

Full comparison — all codes billed, vs. California median

103 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	291	1,550	38,050	$190	$14.1M
99499	Use 99499 to report evaluation and management services for which there is no specific code available.	131	310	190	$100	$301.4K
T1999	Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks"	133	150	2,280	$20	$278.9K
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…	484	13,300	640	$40	$169.6K
J3490	Unclassified drugs	1,089	1,390	670	$20	$159.5K
59425	This service is considered a mini global code for the provider who provides only four to six of the patient’s antepartum visits. This can happen when the patient transfers out of the practice prior…	173	1,040	660	$60	$147.7K
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…	2,795	4,230	210	$110	$135K
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…	328	14,520	760	$10	$122.8K
96158	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of a patient’s physical health…	187	320	590	$40	$75.5K
99204	The provider sees a new 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 provider…	1,979	5,870	180	$70	$73K

Showing 1–10 of 103

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Belmond Community Hospital	IA	Rural Health Clinic/Center	$0	$1.9M
Jonathan Breslau	MN	Diagnostic Radiology Physician	$1.3M	$0
Salar Deldar	CA	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$1.2M	$0
Jinha Park	CA	Diagnostic Radiology Physician	$907.1K	$0
Gloria Hwang	CA	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$589.7K	$0
Abraham Suhr	CA	Ophthalmology Physician	$455K	$0
Jill Wruble	MN	Diagnostic Radiology Physician	$387K	$0
Robert Gardner	CA	Diagnostic Radiology Physician	$335.5K	$0
Denis Atkinson	MN	Diagnostic Radiology Physician	$121.8K	$206.1K
Joshua Albrektson	MN	Diagnostic Radiology Physician	$264.9K	$2K

Southern Monterey County Memorial Hospital — Billing Profile & Reimbursement Data

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Southern Monterey County Memorial 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

Related Providers

Frequently Asked Questions

References