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 1356367270)

Appalachian Regional Healthcare, Inc. is a critical access hospital provider located in West Liberty, Kentucky. This profile covers 0 Medicare and 152 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	476 Liberty Road
City	West Liberty
State	KY
ZIP	41472
Taxonomy	Critical Access Hospital
NPI Enumerated	July 14, 2006

Payer Source	Total Paid
Medicaid	$17.9M
Medicare	$0

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

152 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	8,800	$480	$4.2M
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.	2,250	$680	$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.	2,740	$550	$1.5M
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.	12,760	$100	$1.3M
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	27,140	$30	$678.6K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	78,600	$10	$471.6K
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	8,320	$50	$407.5K
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…	660	$610	$406.4K
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.	1,400	$260	$363K
87631	The lab analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus,…	3,550	$100	$358.1K

Showing 1–10 of 152

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. — 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

152 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.	130	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.	140	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.	97	280	5,700	$120	$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.	131	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	65	90	2,770	$190	$1.3M
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.	93	170	2,610	$250	$1M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	62	110	8,390	$50	$749.1K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	142	340	2,700	$40	$673.3K
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.	127	180	2,960	$110	$672.4K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	60	100	5,870	$70	$670.3K

Showing 1–10 of 152

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
Mercy Health System Corporation	WI	Multi-Specialty Clinic/Center	$0	$13.2M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Frederick Medical Clinic Psc	KY	Rural Health Clinic/Center	$0	$3M
Air Evac Ems Inc.	KY	Air Ambulance	$215.7K	$847.3K

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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