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

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

Prisma Health - Blount Memorial Hospital Inc. (NPI 1619939071)

Prisma Health - Blount Memorial Hospital Inc. is a general acute care hospital provider located in Maryville, Tennessee. This profile covers 0 Medicare and 98 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	Prisma Health - Blount Memorial Hospital Inc.
Address	907 E Lamar Alexander Pkwy
City	Maryville
State	TN
ZIP	37804
Taxonomy	General Acute Care Hospital
NPI Enumerated	April 3, 2006

Payer Source	Total Paid
Medicaid	$14.8M
Medicare	$0

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

98 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.	36,170	$200	$7.4M
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.	23,490	$150	$3.5M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	7,500	$110	$809.9K
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.	2,230	$250	$563.9K
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…	6,470	$60	$407.5K
G0378	Hospital observation service, per hour	2,060	$170	$356.2K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	5,450	$50	$245.2K
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…	43,730	$10	$218.6K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	4,140	$50	$194.3K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	9,960	$10	$139.5K

Showing 1–10 of 98

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Prisma Health - Blount Memorial Hospital Inc. — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

98 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	25	60	1,340	$50	$1.1M
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.	38	630	510	$120	$1.1M
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.	53	610	570	$110	$884.4K
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.	126	570	640	$100	$637.8K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	68	230	2,130	$40	$616.8K
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…	15	100	400	$60	$524.7K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	108	340	1,400	$40	$354.2K
G0378	Hospital observation service, per hour	19	100	410	$210	$264K
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.	124	240	840	$20	$259.2K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	17	180	480	$90	$245.5K

Showing 1–10 of 98

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Donna Brantley	TN	Family Nurse Practitioner	$263.1K	$0
John Reisser	TN	Surgery Physician	$42K	$0
Veronica Gubatan	TN	Psychiatry Physician	$40.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
App Of Tennessee Ed, PLLC	TN	Emergency Medicine Physician	$0	$30.3M
Speech Pathology Services Of East Tennessee LLC	TN	Rehabilitation Clinic/Center	$0	$9.3M
East Tennessee Oral & Maxillofacial Surgery, PC	TN	Oral and Maxillofacial Surgery (Dentist)	$0	$7.1M
East Tennessee Addiction Specialists	TN	Substance Use Disorder Rehabilitation Clinic/Center	$0	$6.5M
Open Hearts Open Arms	TN	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$4.8M
Foothills Pediatric Dentristry, P.C.	TN	Pediatric Dentistry	$0	$2.2M
Maryville Asc	TN	Ambulatory Surgical Clinic/Center	$350.4K	$141.2K
Molecular Pathology Laboratory Network Inc	TN	Clinical Medical Laboratory	$369.4K	$60.8K
Robert Ivy	TN	Orthopaedic Hand Surgery Physician	$231.7K	$0
Qurrat Ul Ain Shamim	TN	Nephrology Physician	$154.3K	$0

Prisma Health - Blount Memorial Hospital 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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