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

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

Upmc Pinnacle Hospitals (NPI 1407813603)

Field	Value
Entity Type	Organization
Organization	Upmc Pinnacle Hospitals
Address	111 S Front St
City	Harrisburg
State	PA
ZIP	17101
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 1, 2006

Payer Source	Total Paid
Medicaid	$26.9M
Medicare	$0

Medicaid: Complete Services Breakdown

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

435 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.	55,780	$110	$6M
G0378	Hospital observation service, per hour	4,330	$750	$3.2M
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.	37,620	$80	$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.	12,140	$110	$1.4M
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…	5,840	$140	$834.5K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	6,090	$80	$487K
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.	2,190	$200	$429.2K
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.	38,750	$10	$426.2K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	68,020	$10	$340.1K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	13,340	$30	$333.6K

Showing 1–10 of 435

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Upmc Pinnacle Hospitals — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

435 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	5	10	1,120	$1,340	$2.5M
G0378	Hospital observation service, per hour	15	150	510	$870	$1.4M
T1015	Clinic visit/encounter, all-inclusive	568	1,690	760	$170	$1.2M
J9271	Injection, pembrolizumab, 1 mg	11	20	420	$1,230	$827.7K
G0480	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…	28	130	310	$60	$769.3K
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.	31	210	730	$40	$689.7K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	38	200	990	$70	$517.5K
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.	20	1,600	270	$120	$409.7K
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.	15	1,060	150	$130	$405.4K
J7307	Etonogestrel (contraceptive) implant system, including implant and supplies	28	30	180	$570	$331.3K

Showing 1–10 of 435

Related Providers

Other providers that share a Tax Identification Number (TIN) with Upmc Pinnacle Hospitals, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saeid Safaee	CA	Pulmonary Disease Physician	$492.5K	$0
Viswanathan Iyer	PA	Nephrology Physician	$302.8K	$5K
Ann Thompson	PA	Surgery Physician	$26.4K	$0
Manish Gupta	PA	Surgery Physician	$16.5K	$0

Nearby Providers

Other providers in the same ZIP code as Upmc Pinnacle Hospitals, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pinnacle Health Emergency Department Services LLC	PA	Emergency Medicine Physician	$0	$14.2M
Allison Ann Lyavdansky	PA	Gerontology Nurse Practitioner	$743.8K	$12.8K
Howard Fugate	PA	Internal Medicine Physician	$205K	$28.5K
Emily Smerilli	PA	Family Nurse Practitioner	$203.6K	$11K
Tracey Shivok-jefferson	PA	Family Nurse Practitioner	$131.1K	$1.7K
Sandra Stom	PA	Family Nurse Practitioner	$118.8K	$820
Karen Bensinger	PA	Nurse Practitioner	$108K	$480
Joshua Ruopp	PA	Certified Registered Nurse Anesthetist	$61K	$0
Tyshaun James-hart	PA	Surgery Physician	$44K	$3.1K
Joshua Stadler	PA	Internal Medicine Physician	$41.8K	$0

Upmc Pinnacle Hospitals — Billing Profile & Reimbursement Data

Sign up for Upmc Pinnacle Hospitals — Billing Profile & Reimbursement Data policy alerts

Upmc Pinnacle Hospitals — Billing Profile & Reimbursement Data

Sign up for Upmc Pinnacle Hospitals — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References