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.

Saint Joseph Health System, Inc (NPI 1740488386)

Saint Joseph Health System, Inc is a critical access hospital provider located in Berea, Kentucky. This profile covers 0 Medicare and 251 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	Saint Joseph Health System, Inc
Address	305 Estill St
City	Berea
State	KY
ZIP	40403
Taxonomy	Critical Access Hospital
NPI Enumerated	July 5, 2007

Payer Source	Total Paid
Medicaid	$29.8M
Medicare	$0

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

251 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.	20,690	$220	$4.4M
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.	27,340	$130	$3.5M
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.	10,910	$240	$2.6M
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.	5,540	$270	$1.5M
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	11,880	$80	$950.7K
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.	27,320	$30	$901.7K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	14,980	$60	$854K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	19,160	$40	$766.4K
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.	2,530	$300	$761.2K
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…	8,800	$60	$563.5K

Showing 1–10 of 251

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

Saint Joseph Health System, Inc — 0 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

251 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	200	310	830	$120	$3.7M
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.	74	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.	69	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.	50	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.	79	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	77	90	2,770	$190	$1.3M
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	23	30	2,320	$290	$1.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	54	80	7,740	$30	$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.	37	170	2,610	$250	$1M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	32	110	8,390	$50	$749.1K

Showing 1–10 of 251

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saint Joseph Health System, Inc	KY	General Acute Care Hospital	$0	$85.5M
Saint Joseph Health System, Inc	KY	Rural Acute Care Hospital	$0	$83.7M
Saint Joseph Health System, Inc	KY	General Acute Care Hospital	$0	$67.4M
Kentuckyone Health Medical Group, Inc.	KY	Family Medicine Physician	$0	$38.9M
Saint Joseph Health System, Inc	KY	General Acute Care Hospital	$0	$37.2M
Robert Lavey	KY	Radiation Oncology Physician	$384.3K	$0
Emmanuel Nidhiry	KY	Medical Oncology Physician	$347.6K	$0
Nicola Jabbour	KY	Hematology & Oncology Physician	$195.8K	$0
Aman Khurana	IL	Internal Medicine Physician	$152.8K	$41.4K
Muhammad Niazi	KY	Hematology & Oncology Physician	$91.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Busy Bee Occupational Therapy	KY	Occupational Therapist	$0	$6M
Berea Urgent Care LLC	KY	Nurse Practitioner	$0	$4.8M
Parsons Counseling, LLC	KY	Mental Health Counselor	$0	$4.1M
The Speech Path PLLC	KY	Speech-Language Pathologist	$0	$3.8M
Bhg Xxxv, LLC	KY	Methadone Clinic	$0	$3.8M
Sarah King	KY	Optometrist	$22.1K	$238.2K
Kristina Burton	KY	Optometrist	$223.8K	$2.2K
Nawar Soda	KY	Family Medicine Physician	$132.3K	$2.6K
Dasen Ritchey	KY	Surgery Physician	$19.2K	$0

Saint Joseph Health System, 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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