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

Why is the Medicaid comparison limited to Kentucky 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. Kentucky (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.

Highlands Hospital Corp (NPI 1194818138)

Field	Value
Entity Type	Organization
Organization	Highlands Hospital Corp
Address	5000 Ky Route 321
City	Prestonsburg
State	KY
ZIP	41653
Taxonomy	Cardiovascular Disease Physician
NPI Enumerated	October 2, 2006

Payer Source	Total Paid
Medicaid	$15.9M
Medicare	$0

Medicaid: Complete Services Breakdown

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

308 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	10,360	$290	$3M
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.	7,080	$220	$1.6M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	18,200	$60	$1.1M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	3,020	$210	$644.1K
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.	1,790	$280	$494.3K
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.	4,350	$110	$487.3K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	480	$950	$458.4K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	6,340	$60	$393.3K
20610	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	2,600	$130	$327.6K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	940	$330	$312.7K

Showing 1–10 of 308

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Highlands Hospital Corp — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

308 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	142	280	7,150	$150	$3M
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.	74	240	4,710	$150	$2.6M
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…	51	70	1,650	$100	$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.	152	280	5,700	$120	$2M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	28	40	740	$1,170	$1.7M
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.	91	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	43	90	2,770	$190	$1.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	21	80	7,740	$30	$1.1M
C1713	Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)	37	40	550	$910	$1.1M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	71	170	2,610	$250	$1M

Showing 1–10 of 308

Related Providers

Other providers that share a Tax Identification Number (TIN) with Highlands Hospital Corp, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Arh Tug Valley Health Services, Inc.	KY	General Acute Care Hospital	$0	$33.8M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Paintsville Hospital Company, LLC	KY	General Acute Care Hospital	$0	$15.5M
Mercy Health System Corporation	WI	Multi-Specialty Clinic/Center	$0	$13.2M
Arh Tug Valley Health Services, Inc.	KY	General Acute Care Hospital	$0	$10.4M
Jason Fogg	KY	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$1.2M	$0
Bahram Forouzandeh	KY	Gastroenterology Physician	$59K	$925.9K
Randall Mann	KY	Optometrist	$38K	$542.8K
Matthew Hrastich	MO	Diagnostic Radiology Physician	$134.1K	$399.7K
Kalpesh Patel	AZ	Diagnostic Radiology Physician	$409.1K	$0

Nearby Providers

Other providers in the same ZIP code as Highlands Hospital Corp, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mountain Comprehensive Care Center, Inc.	KY	Mental Health Counselor	$0	$243M
Mountain Comprehensive Care Center	KY	Case Management Agency	$0	$65.1M
Big Sandy Area Agency On Aging	KY	Supports Brokerage Agency	$0	$56.2M
Jt Associates, Inc	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$7.6M
Commonwealth Counseling Centers LLC	KY	Substance Abuse Rehabilitation Facility	$0	$7.1M
Alan Hyden	KY	Pediatric Dentistry	$0	$6.4M
East Kentucky Rehabilitation Center	KY	Substance Use Disorder Rehabilitation Clinic/Center	$0	$6M
Eastern Kentucky Tender Care Pediatrics LLC	KY	Rural Health Clinic/Center	$0	$5.2M
Floyd Emergency Group, LLC	KY	Emergency Medicine Physician	$0	$4.2M
Cooley Medical Equipment, Inc	KY	Oxygen Equipment & Supplies (DME)	$0	$4.2M

Highlands Hospital Corp — Billing Profile & Reimbursement Data

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Highlands Hospital Corp — 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

Nearby Providers

Frequently Asked Questions

References