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

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

Augusta Health Care, Inc (NPI 1053301127)

Key Findings

Field	Value
Entity Type	Organization
Organization	Augusta Health Care, Inc
Address	78 Medical Center Dr
City	Fishersville
State	VA
ZIP	22939
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 28, 2005

Payer Source	Total Paid
Medicaid	$63.6M
Medicare	$0

This provider is effectively single‑payer in the available files: Medicare billing is listed as none while Total Medicaid revenue is $63.6M, indicating operations and revenue are driven almost entirely by Medicaid reimbursement in the dataset. That concentration should be considered when assessing reimbursement risk and contracting leverage, because there is no Medicare dataset to offset Medicaid exposure.

Revenue is highly concentrated in a small set of Medicaid codes: the precomputed top 3 codes account for 48.5% of the provider's Medicaid revenue. The three leading codes are G0463 ($11.5M, 21.8%), 99283 ($7.6M, 14.3%), and 99284 ($6.5M, 12.4%), which together drive nearly half of reported Medicaid receipts and signal where negotiation and utilization-management attention will have the biggest dollar impact.

The code mix indicates a strong emergency‑and‑outpatient focus. High revenues for G0463 ($11.5M, 21.8%) and multiple ED E/M codes (99282–99285 together account for a substantial share, including 99283 $7.6M and 99284 $6.5M) plus observation codes G0378/G0379 and IV hydration/infusion codes (96361 $5.2M; 96360 $1.1M) point to heavy ED throughput, observation stays, and infusion activity as core service lines.

Competitive standing by code is mixed but shows clear strengths in emergency and testing volumes: G0463 ranks #4 of 70 providers in-state (96th percentile) but is described as "typical, unremarkable volume for this code," while 99283 ranks #38 of 626 (94th percentile) and is labeled "notably above typical state volume," supporting a view that the hospital is an above-average ED provider in Virginia. Conversely many other high‑revenue codes (e.g., 99284, 99285) sit in upper percentiles but are described as typical or unremarkable, suggesting strong but not dominant statewide breadth beyond key ED lines.

The provider is a clear outlier for SARS–CoV–2 testing: 87635 has 27.6K claims, $55 avg paid/claim, $1.5M revenue (2.9% of Medicaid revenue) and ranks #1 of 227 providers in-state (100th percentile) as an "extreme outlier, far above typical state volume." This indicates unusually large COVID testing throughput relative to peers and may reflect either a centralized testing role or historically high outpatient lab activity during the pandemic period.

Imaging and diagnostic services form a meaningful secondary revenue stream that supports ED and inpatient workflows. Notable lines include CT abdomen/pelvis with contrast 74177 ($1.8M, 3.4%), CT head 70450 ($1.4M, 2.6%), CTA chest 71275 ($457K, 0.9%), and abdominal ultrasound 76705 ($444.1K, 0.8%), consistent with on‑site radiology capacity that complements the high ED volume.

Procedural and ancillary service capacity is evident in endoscopy, cardiology imaging, and therapy codes: 43239 endoscopy ($1.1M, 2.1%, rank #14 of 146, 91st percentile), 45380 colonoscopy ($809.2K, 1.5%, rank #13 of 89, 86th percentile), and 93306 echocardiography ($772.9K, 1.5%, rank #54 of 211, 75th percentile) all report meaningful revenues. Physical and rehabilitative services are present as well (97110 $1.3M, 2.4%; 97163 $523.1K, 1.0% with a "notably above typical state volume" descriptor), indicating breadth beyond acute emergency care.

The organization has an established operational tenure: NPI enumerated 2005-10-28 (~21 years ago), which suggests long-standing presence in the market and supports interpretation of the observed utilization patterns as mature service lines rather than nascent shifts. Analysts should treat the Medicaid-driven pattern as characteristic of its current business profile and prioritize Medicaid-level benchmarking when evaluating performance and opportunity areas.

Medicaid: Complete Services Breakdown

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

426 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	100,180	$120	$11.5M
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.	46,380	$160	$7.6M
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.	40,140	$160	$6.5M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	19,260	$270	$5.2M
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.	21,820	$180	$3.9M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	13,450	$150	$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.	8,810	$200	$1.8M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	27,620	$60	$1.5M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	8,280	$170	$1.4M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	27,140	$50	$1.3M

Showing 1–10 of 426

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Augusta Health Care, Inc — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

426 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	16	90	9,030	$280	$3.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	4	70	3,200	$110	$2.8M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	22	30	600	$1,370	$1.7M
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.	44	340	160	$130	$1.3M
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.	38	630	90	$140	$1.1M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	25	140	3,240	$160	$1M
G0378	Hospital observation service, per hour	8	80	3,650	$160	$1M
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.	39	620	70	$120	$1M
J0585	Injection, onabotulinumtoxina, 1 unit	7	20	750	$540	$871.7K
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.	40	180	2,950	$140	$783.2K

Showing 1–10 of 426

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Augusta Medical Group	VA	General Practice Physician	$0	$12.6M
Sainath Gaddam	TX	Interventional Cardiology Physician	$251.9K	$538.3K
Ashkan Karimi	VA	Interventional Cardiology Physician	$775.6K	$0
Sumit Duggal	MD	Cardiovascular Disease Physician	$648.3K	$0
David Wood	CA	Diagnostic Radiology Physician	$641.3K	$2.7K
Todd Blodgett	PA	Diagnostic Radiology Physician	$380.1K	$254K
Timothy Kane	VA	Psychiatry Physician	$429.4K	$103.4K
James Sluss	VA	Diagnostic Radiology Physician	$364K	$90K
Atul Gupta	VA	Diagnostic Radiology Physician	$319.1K	$120.4K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Shenandoah Emergency Medicine Specialists LLC	VA	Emergency Medicine Physician	$0	$7.5M
Shil Patel	VA	Ophthalmology Physician	$6.1M	$0
Ashley Blurton	VA	Nuclear Medicine Physician	$2.9M	$0
Yevgeniy Shildkrot	VA	Ophthalmology Physician	$1.5M	$0
Blue Ridge Pathologists PC	VA	Anatomic Pathology Physician	$224.6K	$1.2M
James Tiedeman	VA	Ophthalmology Physician	$782.7K	$0
William Jones	VA	Urology Physician	$468.4K	$0
David Barnes	VA	Specialist	$405.8K	$150
Rachna Patel	VA	Specialist	$377K	$0
Glenn Brammer	VA	Clinical Cardiac Electrophysiology Physician	$375.6K	$0

Augusta Health Care, Inc — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References