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

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

Pinnacle Health Medical Services (NPI 1932143427)

Pinnacle Health Medical Services is a family medicine physician provider located in Harrisburg, Pennsylvania. This profile covers 0 Medicare and 160 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	Pinnacle Health Medical Services
Address	409 S 2nd St
City	Harrisburg
State	PA
ZIP	17104
Taxonomy	Family Medicine Physician
NPI Enumerated	June 15, 2006

Payer Source	Total Paid
Medicaid	$14.1M
Medicare	$0

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

160 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	82,950	$60	$5.2M
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…	76,280	$50	$3.4M
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	5,490	$90	$472.2K
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…	8,990	$50	$422.5K
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…	4,430	$90	$398.7K
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…	3,520	$90	$306.3K
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,…	7,410	$40	$303.8K
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…	1,450	$210	$301K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,180	$90	$296.1K
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.	3,020	$100	$290.2K

Showing 1–10 of 160

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Pinnacle Health Medical Services — 12 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

160 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1016	Case management, each 15 minutes	111	160	2,180	$80	$965.8K
J7298	Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg	15	20	100	$680	$589.6K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	436	560	1,400	$90	$485.7K
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.	1,005	1,600	270	$120	$409.7K
H0004	Behavioral health counseling and therapy, per 15 minutes	565	1,410	820	$160	$353.5K
J7307	Etonogestrel (contraceptive) implant system, including implant and supplies	17	30	180	$570	$331.3K
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.	794	1,230	250	$130	$284K
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	100	300	$130	$129.8K
T1028	Assessment of home, physical and family environment, to determine suitability to meet patient's medical needs	7	10	180	$90	$111.8K
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,…	24	90	150	$270	$105.5K

Showing 1–10 of 160

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ohiohealth Corporation	OH	Family Medicine Physician	$0	$89.1M
Enrico Giangeruso	VA	Anatomic Pathology & Clinical Pathology Physician	$1.4M	$0
Susan Lee	NJ	Internal Medicine Physician	$769K	$0
Daniel Kim	PA	Orthopaedic Surgery Physician	$451K	$2.2K
Henry Venbrux	PA	Anatomic Pathology & Clinical Pathology Physician	$416.5K	$18.3K
Kelly Caruso	PA	Family Medicine Physician	$29.2K	$390.6K
John Ellsworth	UT	Urology Physician	$398.1K	$0
Adam Buerk	PA	Orthopaedic Surgery Physician	$368.8K	$19.3K
Curtis Goltz	PA	Orthopaedic Surgery Physician	$346K	$11.4K
Maseer Bade	PA	Vascular Surgery Physician	$343.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hamilton Health Center, Inc.	PA	Federally Qualified Health Center (FQHC)	$0	$37.4M
Community Lifeteam, Inc.	PA	Land Ambulance	$2.7M	$17.3M
Cmu	PA	Case Management Agency	$0	$15.8M
Cmu	PA	Case Management Agency	$0	$9.6M
Ophthalmology Surgical Center, Inc	PA	Ambulatory Surgical Clinic/Center	$404.4K	$0
Yujian Chen	PA	Foot & Ankle Surgery Podiatrist	$223.6K	$0
Jonathan Enterline	PA	Diagnostic Radiology Physician	$187.4K	$12.1K
David Loran	PA	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	$146.2K	$0
Nathaniel Melton	PA	Surgery Physician	$94.4K	$0
Ahmad Abrishamchian	PA	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	$94.1K	$0

Pinnacle Health Medical Services — Billing Profile & Reimbursement Data

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Pinnacle Health Medical Services — 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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