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 1669506523)

Appalachian Regional Healthcare, Inc is a rural health clinic/center provider located in Harlan, Kentucky. This profile covers 0 Medicare and 124 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	37 Ball Park Road
City	Harlan
State	KY
ZIP	40831
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	March 15, 2007

Payer Source	Total Paid
Medicaid	$8M
Medicare	$0

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

124 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	80,460	$40	$2.9M
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…	39,050	$40	$1.6M
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	23,300	$30	$652.4K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	12,540	$40	$438.7K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	4,380	$50	$197.1K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	3,160	$60	$192.6K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	2,700	$60	$172.7K
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,…	5,870	$30	$164.4K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	1,690	$90	$159K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	1,110	$110	$124.5K

Showing 1–10 of 124

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 — 3 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

124 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	78	210	1,340	$160	$568K
47562	The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease.	33	40	120	$1,340	$494.5K
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…	118	130	6,080	$40	$449.7K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	93	170	1,300	$230	$441K
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	92	130	420	$270	$375.3K
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…	60	3,340	1,020	$30	$296K
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…	121	160	420	$140	$270.5K
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…	52	2,460	580	$40	$245K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	107	120	300	$320	$215.2K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	58	470	770	$20	$188.2K

Showing 1–10 of 124

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
Appalachian Regional Healthcare, Inc.	KY	Critical Access Hospital	$0	$17.9M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
H & A Counseling, Psc	KY	Mental Health Counselor	$0	$5.8M
Horizon Adult Health Care LLC	KY	Occupational Therapist	$0	$3.8M
Air Evac Ems Inc.	KY	Air Ambulance	$550.9K	$2.2M
Abdulkader Dahhan	KY	Internal Medicine Physician	$200.5K	$2.4M
Mercy Ambulance Of Evansville Inc	KY	Ambulance	$567.9K	$819.9K
Jayaramakrishna Depa	KY	Nephrology Physician	$149.2K	$0
Gregory Dye	KY	Family Medicine Physician	$72K	$0
Opal Prevatt	KY	Internal Medicine Physician	$52.8K	$0
Syed Raza	KY	Psychiatry Physician	$49.5K	$0
Kristin Delaney	KY	Family Nurse Practitioner	$32.2K	$0

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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