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

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

Dalton Ear Nose & Throat Associates (NPI 1396890257)

Dalton Ear Nose & Throat Associates is a otolaryngology physician provider located in Dalton, Georgia. This profile covers 0 Medicare and 17 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	Dalton Ear Nose & Throat Associates
Address	1436 Chattanooga Ave
City	Dalton
State	GA
ZIP	30720
Taxonomy	Otolaryngology Physician
NPI Enumerated	January 23, 2007

Payer Source	Total Paid
Medicaid	$4M
Medicare	$0

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

17 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	3,680	$510	$1.9M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	1,540	$500	$767.5K
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…	3,720	$120	$439.3K
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…	9,230	$40	$406.3K
92567	In this procedure, the provider measures the functioning of the middle ear by varying the pressure of air presented to the ear to identify the reason for hearing loss.	9,170	$20	$155.9K
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…	1,770	$80	$140K
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…	1,960	$60	$115.3K
92579	The provider performs a battery of tests to evaluate hearing loss in infants and toddlers. He uses sound sources to evaluate the auditory response, with reinforcement by animated toys.	2,670	$30	$69.5K
92555	The provider measures a patient’s speech reception/awareness threshold (the lowest volume at which the patient can recognize speech).	1,590	$10	$22.3K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	90	$150	$13.3K

Showing 1–10 of 17

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Georgia Distribution

Dalton Ear Nose & Throat Associates — 2 of 17 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia median

17 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	2	20	190	$1,120	$833.4K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	2	20	260	$560	$608.1K
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…	115	920	370	$60	$360.6K
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	7	10	30	$920	$289K
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…	214	820	390	$70	$245K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	15	30	90	$160	$236.3K
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,…	328	360	370	$50	$153.6K
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…	40	310	90	$90	$136.3K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	13	20	110	$200	$105.6K
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…	9	230	100	$110	$97.1K

Showing 1–10 of 17

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sean Coleman	GA	Allergy & Immunology Physician	$67.2K	$0
Stephen Ryals	GA	Allergy & Immunology Physician	$56.5K	$0
David Dinges	GA	Allergy & Immunology Physician	$54.9K	$0
Alyssa Garner	GA	Family Nurse Practitioner	$36.2K	$0
Katy Poole	GA	Family Nurse Practitioner	$27.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Highland Rivers Community Service Board	GA	Community/Behavioral Health Agency	$0	$44.1M
White's Pediatrics	GA	Pediatrics Physician	$0	$25.1M
Family And Children First LLC	GA	Community/Behavioral Health Agency	$0	$19.5M
Hamilton Physician Group Inc	GA	Cardiovascular Disease Physician	$0	$5.9M
Pediatrics Of Dalton, PA	GA	Specialist	$0	$5.5M
Skin Cancer & Cosmetic Dermatology Center, PC	GA	Dermatology Physician	$0	$3.4M
John Chung	GA	MOHS-Micrographic Surgery Physician	$2.5M	$0
Hamilton Emergency Medical Services	GA	Land Ambulance	$1.2M	$0
Hosam Saad-naguib	GA	Hematology & Oncology Physician	$1M	$0
Professional Eye Associates, Inc.	GA	Ambulatory Surgical Clinic/Center	$698.9K	$0

Dalton Ear Nose & Throat Associates — Billing Profile & Reimbursement Data

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Dalton Ear Nose & Throat Associates — 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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