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.

St Claire Medical Center, Inc., (NPI 1740581198)

St Claire Medical Center, Inc., is a cardiovascular disease physician provider located in Morehead, Kentucky. This profile covers 0 Medicare and 55 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	St Claire Medical Center, Inc.,
Address	234 Medical Cir Ste 1
City	Morehead
State	KY
ZIP	40351
Taxonomy	Cardiovascular Disease Physician
NPI Enumerated	November 16, 2010

Payer Source	Total Paid
Medicaid	$3.3M
Medicare	$0

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

55 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…	24,530	$30	$784.9K
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…	22,430	$30	$740.3K
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…	4,880	$50	$258.4K
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…	3,990	$60	$227.6K
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.	1,900	$90	$161.5K
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…	4,390	$30	$149.3K
99204	The provider sees a new 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 provider…	1,880	$70	$123.8K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	530	$210	$110.1K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	2,560	$30	$69.2K
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	420	$160	$67.4K

Showing 1–10 of 55

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

St Claire Medical Center, Inc., — 1 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

55 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…	37	210	1,340	$160	$568K
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…	30	60	170	$780	$500.2K
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.	64	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…	36	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…	275	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…	82	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…	96	2,460	580	$40	$245K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	66	70	230	$420	$228.2K
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…	80	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…	391	470	770	$20	$188.2K

Showing 1–10 of 55

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Claire Medical Center Inc	KY	General Acute Care Hospital	$0	$71.2M
St Claire Medical Center Inc.	KY	Emergency Medicine Physician	$0	$4M
St. Claire Medical Center, Inc	KY	Family Medicine Physician	$0	$3.3M
St. Claire Medical Center, Inc	KY	Home Health Agency	$0	$3.1M
Tariq Mahmood	OK	Medical Oncology Physician	$253.8K	$17.8K
Eusebio Desuyo	ND	Pulmonary Disease Physician	$132.6K	$0
Matthew Shotwell	KY	Interventional Cardiology Physician	$109.3K	$0
Samuel Quaynor	GA	Neurology Physician	$93.9K	$14.6K
Steven Koenig	KY	Pulmonary Disease Physician	$104.5K	$0
Obiora Maludum	TN	Interventional Cardiology Physician	$104.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Edgewater Recovery Center LLC	KY	Substance Abuse Rehabilitation Facility	$0	$50.3M
D&s Residential Services, LP	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$33.6M
Gateway Area Development District	KY	Supports Brokerage Agency	$0	$20.8M
Lincare Inc.	KY	Durable Medical Equipment & Medical Supplies	$0	$3.4M
St Claire Medical Center, Inc	KY	Urgent Care Clinic/Center	$0	$3.3M
Rowan County Fiscal Court	KY	Land Ambulance	$384.7K	$767.5K
Christian Weigel	KY	Internal Medicine Physician	$105K	$0
Andrei Korossy	KY	Physical Therapist	$89.6K	$0
Lacinda Rishel	KY	Physician Assistant	$82.7K	$0
Alisha Perry	KY	Physician Assistant	$55.1K	$0

St Claire Medical Center, Inc., — Billing Profile & Reimbursement Data

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St Claire Medical Center, 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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