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.

High Risk Obstetrical Consultants, PLLC (NPI 1770724676)

Key Findings

Field	Value
Entity Type	Organization
Organization	High Risk Obstetrical Consultants, PLLC
Address	1930 Alcoa Hwy Ste A435
City	Knoxville
State	TN
ZIP	37920
Taxonomy	Maternal & Fetal Medicine Physician
NPI Enumerated	March 23, 2009

Payer Source	Total Paid
Medicaid	$32.6M
Medicare	$0

HIGH RISK OBSTETRICAL CONSULTANTS, PLLC reports $32.6M in lifetime Medicaid revenue and has no Medicare billing on file, making its public payer footprint effectively single‑payer (Medicaid) in the available data. This concentration on Medicaid should shape payer negotiations, network decisions, and utilization benchmarking against state peers rather than national Medicare comparators.

Revenue for this provider is highly concentrated in a small set of fetal imaging and surveillance codes: the top 3 Medicaid codes (76819, 76816, 76820) account for 50.5% of this provider's total Medicaid revenue. Those three codes—76819 (20.6% of Medicaid revenue), 76816 (15.2%), and 76820 (14.7%)—point to an imaging‑driven revenue model where biophysical profiles, follow‑up ultrasounds, and Doppler studies are the primary revenue drivers.

The code mix shows a clinical focus on intensive fetal surveillance and diagnostic imaging rather than delivery care alone. High‑revenue ultrasound codes beyond the top three include 76811 ($4.3M, 13.3%) and 76821 ($1.3M, 4.1%), and the presence of fetal echocardiography (76825) and first‑trimester nuchal translucency (76813) suggests a specialized Maternal & Fetal Medicine service line with broad diagnostic offerings.

This provider is a dominant statewide performer for several imaging codes: 76811 ranks #1 of 58 providers in Tennessee (100th percentile), 76819 ranks #2 of 95 (99th percentile, labeled an extreme outlier), 76816 ranks #3 of 148 (99th percentile, extreme outlier), and 76820 ranks #2 of 48 (98th percentile). Those rank/percentile positions indicate volumes that are far above typical state peers and imply the provider is a major referral destination for complex fetal imaging.

Evaluation & management (E/M) activity is also substantial and integrated with the imaging volume—99213 has 52.1K claims and $3.2M revenue (9.9% of Medicaid revenue) and 99214 contributes $2.5M (7.6%). High claim counts and state‑level ranks (99213 ranks #81 of 4050, 98th percentile) indicate the practice combines high‑throughput imaging with frequent office follow‑up and consult visits, consistent with an ambulatory MFM clinic model.

Several ancillary codes show unusually high throughput relative to peers, for example 81003 (urine dipstick automated read) with 52.8K claims and $105.6K revenue (0.3% of Medicaid revenue) and a rank of #6 of 788 providers in‑state (99th percentile, extreme outlier). This pattern suggests the site handles high visit volumes with routine point‑of‑care testing accompanying imaging and E/M encounters.

Procedures for inpatient deliveries are present but represent a small share of Medicaid revenue and activity for this provider: 59514 has 145 claims and $134.4K (0.4% of Medicaid revenue) and 59409 has 105 claims and $101.4K (0.3%). These modest volumes and middling ranks imply the practice’s operational emphasis is prenatal diagnostic and surveillance services rather than serving as a high‑volume delivery unit.

The NPI was enumerated on 2009-03-23 (~17 years ago), indicating an established presence in the market. Coupled with persistent high rankings across multiple specialized fetal imaging codes, the tenure supports the interpretation that the provider has built sustained referral relationships and a stable role within Tennessee Medicaid maternal‑fetal services.

Medicaid: Complete Services Breakdown

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

42 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	77,820	$90	$6.7M
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	56,050	$90	$4.9M
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	73,770	$70	$4.8M
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	22,680	$190	$4.3M
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…	52,060	$60	$3.2M
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…	26,890	$90	$2.5M
76821	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the middle cerebral artery. This test determines the timing of labor induction and…	15,650	$90	$1.3M
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	11,330	$90	$1M
99203	The provider sees a new 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 provider…	8,110	$100	$811.3K
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…	5,120	$140	$732.2K

Showing 1–10 of 42

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

High Risk Obstetrical Consultants, PLLC — 13 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

42 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	1	60	320	$140	$346.9K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	2	100	670	$60	$342.9K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	2	50	490	$50	$333.3K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	3	150	390	$60	$220.9K
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…	116	3,760	610	$40	$202.3K
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…	81	4,050	620	$30	$183.9K
76825	The provider performs real–time fetal echocardiography, with or without M–mode recording, for complete evaluation of a fetal cardiovascular system.	8	20	150	$130	$157.5K
76821	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the middle cerebral artery. This test determines the timing of labor induction and…	1	20	200	$60	$143.8K
93325	The provider performs Doppler echocardiography, a diagnostic procedure based on the Doppler effect of sound, color flow velocity mapping, a two–dimensional image representation of blood flow in the…	37	60	780	$30	$126.4K
76818	The provider performs a biophysical profile test to measure the health of the baby during pregnancy. The test consists of a nonstress test and an ultrasound.	6	20	140	$90	$112K

Showing 1–10 of 42

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Laboratory Corporation Of America	TN	Clinical Medical Laboratory	$5.2M	$19.8M
University Health System, Inc.	TN	General Acute Care Hospital	$0	$13.8M
Regional Neonatal Associates	TN	Neonatal-Perinatal Medicine Physician	$0	$9.4M
Association Of University Radiologists, PC	TN	Diagnostic Radiology Physician	$0	$6M
Cherokee Farm Orthopedic Surgery Center, LLC	TN	Ambulatory Surgical Clinic/Center	$2.6M	$0
University Of Tennessee	TN	Multi-Specialty Clinic/Center	$0	$2.6M
State Of Tennessee	TN	Clinical Medical Laboratory	$0	$2.4M
Pediatric Consultants Of East Tennessee	TN	Pediatrics Physician	$0	$2.1M
Lynellen Gregory	TN	Vascular Surgery Physician	$415.1K	$0
Paul Pruett	TN	Glaucoma Specialist (Ophthalmology) Physician	$410.4K	$0

High Risk Obstetrical Consultants, PLLC — Billing Profile & Reimbursement Data

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High Risk Obstetrical Consultants, PLLC — 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

Nearby Providers

Frequently Asked Questions

References