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.

Pikeville Medical Center Inc (NPI 1285621623)

Key Findings

Field	Value
Entity Type	Organization
Organization	Pikeville Medical Center Inc
Address	911 Bypass Rd
City	Pikeville
State	KY
ZIP	41501
Taxonomy	General Acute Care Hospital
NPI Enumerated	September 30, 2005

Payer Source	Total Paid
Medicaid	$181.5M
Medicare	$0

This provider is effectively single-payer in the dataset: there is no Medicare billing on file and all reported lifetime revenue is Medicaid-only at $181.5M. The absence of Medicare activity means payer diversification is minimal in the available claims data, so analyses should treat Medicaid as the dominant revenue source for operational and risk assessments.

Revenue is highly concentrated in a small set of outpatient, ED and imaging services: the top three Medicaid codes (G0463, 99284, 74177) account for 33.1% of this provider's total Medicaid revenue. Specifically, G0463 generated $14M (14.7% of Medicaid revenue, 501.2K claims), 99284 generated $8.9M (9.3%, 48K claims), and 74177 generated $8.6M (9.1%, 16.5K claims), indicating these line items drive a large share of Medicaid receipts.

The code mix points to a high-throughput acute-care hospital operation with a busy emergency department, extensive outpatient clinic throughput, and strong imaging volume. Emergency E/M codes are prominent (99285 with 36.3K claims/$7.9M and 99283 with 41.8K claims/$5.2M), observation services appear at scale (G0378 18.3K claims/$2.8M), and cross-sectional imaging is a major revenue source (74177 16.5K claims/$8.6M, 74176 13.7K claims/$5.4M, 70450 15.8K claims/$2.9M).

Against in-state peers this provider is a dominant participant for several high-volume outpatient and procedural codes. G0463 ranks #2 of 77 providers in-state (99th percentile; extreme outlier), 99212 ranks #8 of 1446 providers (100th percentile; extreme outlier), and 96372 ranks #2 of 865 providers (100th percentile; extreme outlier), signaling market-leading volume in hospital outpatient clinic visits and many basic injection/infusion procedures.

The provider also shows notable laboratory and respiratory testing capacity that contributes materially to Medicaid revenue. Proprietary/PLA testing 0202U has 18.7K claims and $5.5M revenue and ranks #2 of 27 in-state (96th percentile; notably above typical), while multiplex influenza/respiratory testing 87502 has 19.3K claims/$1.7M and ranks #3 of 191 (99th percentile; extreme outlier), indicating concentrated lab throughput for respiratory diagnostics.

High counts for infusion and injection administration codes indicate substantial outpatient therapeutic throughput beyond imaging and ED care: 96372 has 69.6K claims/$2.7M (rank #2 of 865, 100th percentile; extreme outlier), 96374 has 43.1K claims/$2.2M, and 96365 has 31.6K claims/$2.1M. These volumes suggest significant use of nursing/infusion resources and ambulatory procedure capacity that underpin a meaningful share of Medicaid service delivery.

Several additional codes are well above typical in-state volumes, highlighting areas of competitive advantage and operational scale. Examples include 20610 (13.5K claims/$1.9M, rank #4 of 136, 98th percentile; extreme outlier), 74178 (2.9K claims/$1.7M, rank #2 of 41, 98th percentile; notably above typical), and 93306 echocardiography (11.7K claims/$3.5M, 93rd percentile), which together portray broad procedural and imaging capabilities beyond core ED throughput.

This entity has been long-standing in the provider registry (NPI enumerated 2005-09-30 (~21 years ago)), and the combination of tenure plus $181.5M in Medicaid revenue supports characterization as an established regional acute-care hospital. Given the concentrated revenue mix (top three codes = 33.1%), payers and network analysts should treat changes in reimbursement or utilization for these specific codes as having outsized budgetary and contracting implications for this provider.

Medicaid: Complete Services Breakdown

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

733 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	501,200	$30	$14M
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.	47,960	$190	$8.9M
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.	16,480	$520	$8.6M
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.	36,280	$220	$7.9M
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	18,750	$300	$5.5M
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.	13,720	$390	$5.4M
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.	41,830	$130	$5.2M
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…	11,720	$300	$3.5M
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.	15,770	$190	$2.9M
G0378	Hospital observation service, per hour	18,310	$150	$2.8M

Showing 1–10 of 733

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

Pikeville Medical Center Inc — 12 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

733 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	107	310	830	$120	$3.7M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	6	10	4,350	$560	$3.3M
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.	23	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.	23	240	4,710	$150	$2.6M
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.	23	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.	10	40	740	$1,170	$1.7M
J3380	Injection, vedolizumab, intravenous, 1 mg	5	10	110	$5,930	$1.6M
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.	14	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	8	90	2,770	$190	$1.3M
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	2	30	2,320	$290	$1.2M

Showing 1–10 of 733

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Pikeville Medical Center Inc.	KY	Multi-Specialty Clinic/Center	$0	$34.2M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Jefferson Radiology, PC	CT	Diagnostic Radiology Physician	$0	$14M
Rami Sartawi	NY	Vascular & Interventional Radiology Physician	$3.7M	$4.9M
Sujata Gutti	KY	Neurology Physician	$82.9K	$3.7M
Pamela Wells	TN	Diagnostic Radiology Physician	$827K	$0
Linda Armstrong	GA	Diagnostic Radiology Physician	$643.9K	$175.1K
Sainath Gaddam	TX	Interventional Cardiology Physician	$251.9K	$538.3K
Aalap Majmudar	KY	Internal Medicine Physician	$638.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dungarvin Kentucky, LLC - Pikeville	KY	Developmentally Disabled Services Day Training Agency	$0	$16.3M
Appalachian Community Care LLC	KY	Professional Counselor	$0	$13.1M
Joshua Raleigh	KY	Pediatric Dentistry	$0	$7.8M
Bhg Xxv, LLC	KY	Substance Use Disorder Rehabilitation Clinic/Center	$228K	$6.3M
Renew Residential Treatment Services	KY	Substance Abuse Rehabilitation Facility	$0	$4.9M
Stepping Stones LLC	KY	Substance Use Disorder Rehabilitation Clinic/Center	$0	$4.6M
Chad Street	KY	Oral and Maxillofacial Surgery (Dentist)	$0	$3.8M
Addiction Recovery Care LLC	KY	Substance Abuse Rehabilitation Facility	$0	$3.7M
Compassion Services	KY	Rural Health Clinic/Center	$0	$3.3M
Pikeville Radiology PLLC	KY	Diagnostic Radiology Physician	$0	$3.2M

Pikeville Medical Center Inc — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References