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.

Appalachian Regional Healthcare, Inc (NPI 1205400421)

Appalachian Regional Healthcare, Inc is a rural health clinic/center provider located in Hazard, Kentucky. 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	Appalachian Regional Healthcare, Inc
Address	200 Medical Center Dr
City	Hazard
State	KY
ZIP	41701
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	May 13, 2021

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
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	17,780	$30	$569K
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…	14,280	$30	$414.1K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	15,280	$30	$412.6K
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…	10,570	$40	$412.2K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	8,020	$40	$296.7K
99203	The provider sees a new 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 provider…	4,920	$50	$236.1K
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…	2,870	$60	$175K
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.	1,770	$90	$150.2K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	790	$110	$88.7K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	1,130	$70	$81.6K

Showing 1–10 of 54

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

Appalachian Regional Healthcare, Inc — 2 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

54 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	119	210	1,340	$160	$568K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	796	1,270	760	$80	$447.2K
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.	70	170	1,300	$230	$441K
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	114	130	420	$270	$375.3K
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…	439	3,340	1,020	$30	$296K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	54	160	420	$140	$270.5K
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…	195	2,460	580	$40	$245K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	34	120	300	$320	$215.2K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	47	470	770	$20	$188.2K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	77	110	230	$340	$175.7K

Showing 1–10 of 54

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$107.9M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$55.1M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$38.9M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$33.4M
Union Associated Physicians Clinic, LLC	IN	Family Medicine Physician	$0	$31.1M
Appalachian Regional Healthcare, Inc.	KY	Critical Access Hospital	$0	$26.9M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$26.8M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Appalachian Regional Healthcare, Inc	WV	General Acute Care Hospital	$0	$18.3M
Appalachian Regional Healthcare, Inc.	KY	Critical Access Hospital	$0	$17.9M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kentucky River Community Care, Inc	KY	Specialist	$0	$109.1M
Kentucky River Community Care, Inc	KY	Mental Health Counselor	$0	$104M
Kentucky River Area Dev Dist	KY	Supports Brokerage Agency	$0	$43.4M
Primary Care Centers Of Eastern Kentucky, LLC	KY	Rural Health Clinic/Center	$0	$26.2M
Soaring Potentials Lllp	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$20.4M
Bhg Xxvi, LLC	KY	Substance Use Disorder Rehabilitation Clinic/Center	$493.7K	$16.1M
Southern Medical Partners, LLC	KY	Emergency Medicine Physician	$0	$15.6M
Dungarvin Kentucky, LLC - Hazard	KY	Developmentally Disabled Services Day Training Agency	$0	$10.1M
Quantum Healthcare Associates Inc	KY	General Practice Physician	$0	$9.1M
Community Alternatives Kentucky, Inc.	KY	Case Management Agency	$0	$7.6M

Appalachian Regional Healthcare, Inc — Billing Profile & Reimbursement Data

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Appalachian Regional Healthcare, Inc — 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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