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 1609869916)

Key Findings

Field	Value
Entity Type	Organization
Organization	Appalachian Regional Healthcare, Inc.
Address	100 Medical Center Dr
City	Hazard
State	KY
ZIP	41701
Taxonomy	General Acute Care Hospital
NPI Enumerated	August 23, 2005

Payer Source	Total Paid
Medicaid	$107.9M
Medicare	$0

This facility reports no Medicare billing on file and is effectively a Medicaid-centric provider: Total Medicare revenue is none (no Medicare billing on file) while total Medicaid revenue is $107.9M. That single-payer exposure means the provider’s financial performance and utilization profile are driven entirely by Medicaid reimbursement and policy changes.

Revenue concentration is high: the top three Medicaid codes — 99284 ($13.9M, 19.0%), 99285 ($10.7M, 14.7%), and G0378 ($9.2M, 12.7%) — together account for 46.4% of the provider’s total Medicaid revenue. This concentration signals that emergency department evaluation & management and hospital observation services are the primary revenue drivers for the organization.

The code mix points to a strong emergency and acute care operating model. High volumes and dollar shares for 99284 and 99285 indicate extensive ED throughput covering moderate- and high-complexity visits, and G0378 (hospital observation service, per hour) at $9.2M further suggests substantial observation-unit activity tied to ED dispositions. Together these codes imply core service lines oriented around emergency evaluation, short-term observation, and conversion to inpatient or procedural care when needed.

Competitive standing across key codes is mixed: 99284 ranks #41 of 282 in-state (86th percentile) and 99285 ranks #38 of 239 (84th percentile), both labelled as typical, unremarkable volumes for those ED E/M codes, so the hospital is not dominant statewide on routine ED visits. In contrast, G0378 is ranked #5 of 87 (95th percentile) and is described as notably above typical state volume, indicating this provider is a comparatively large provider of observation-hour services in Kentucky.

Imaging and procedural services supplement the ED/observation footprint: 74177 (CT abdomen/pelvis with contrast) accounts for $5.7M (7.8% of Medicaid revenue) and 74176 (CT without contrast) $3.5M (4.8%). Several imaging and cardiac procedure codes show elevated state standing — 93458 (imaging for left heart catheterization) is $2.3M and ranks #5 of 56 (93rd percentile, notably above typical state volume) — indicating a meaningful volume of advanced diagnostic and interventional imaging tied to acute cardiac care.

The hospital shows above-typical statewide volumes for several supportive services that align with high ED throughput and inpatient care: 85025 (CBC) generated $1.7M and ranks #11 of 310 (97th percentile; notably above typical state volume), 43239 (EGD with biopsy) $2.0M and ranks #12 of 174 (94th percentile; notably above typical state volume), and 72148 (lumbar MRI) $1.7M and ranks #9 of 136 (94th percentile; notably above typical state volume). These elevated lab, endoscopy, and MRI ranks suggest robust ancillary service capacity beyond basic ED care.

Critical care and observation intensity are also present: 99291 (critical care, first 30–74 minutes) produced $2.2M (2.9% of Medicaid revenue) and ranks #22 of 158 in-state (87th percentile; typical, unremarkable volume), while G0463 (hospital outpatient clinic visit) tallied $1.7M with 112.5K claims and ranks #5 of 77 (95th percentile; described as typical, unremarkable volume). These patterns indicate the hospital provides a mix of critical care, high ED acuity, and sizable outpatient clinic activity rather than being limited to low-acuity services.

The provider has a long enrollment history, with its NPI enumerated on 2005-08-23 (~21 years ago), which supports interpreting these utilization patterns as established operational behavior rather than a recent change. Given the Medicaid-only revenue base ($107.9M) and the high revenue concentration in a few ED/observation codes (46.4% from the top three), the facility appears operationally focused on emergency/observation throughput with strong ancillary imaging and lab volumes, and is materially exposed to Medicaid payment or policy shifts that affect those service lines.

Medicaid: Complete Services Breakdown

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

505 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.	32,300	$430	$13.9M
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.	22,040	$490	$10.7M
G0378	Hospital observation service, per hour	26,720	$350	$9.2M
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.	7,930	$720	$5.7M
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.	6,630	$520	$3.5M
93458	In this procedure, the provider performs imaging supervision and interpretation for a coronary angiography with left heart catheterization and intraprocedural injections for left ventriculography. He…	2,220	$1,040	$2.3M
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.	103,970	$20	$2.3M
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…	6,010	$380	$2.3M
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.	9,690	$230	$2.2M
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…	3,370	$640	$2.2M

Showing 1–10 of 505

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

505 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.	41	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.	38	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.	73	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.	43	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	5	90	2,770	$190	$1.3M
C1776	Joint device (implantable)	17	20	130	$2,890	$1.1M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	5	80	7,740	$30	$1.1M
C1713	Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)	39	40	550	$910	$1.1M
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.	29	170	2,610	$250	$1M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	14	50	2,340	$200	$829.7K

Showing 1–10 of 505

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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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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
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
Mercy Health System Corporation	WI	Multi-Specialty Clinic/Center	$0	$13.2M