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

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

Virginia Gay Hospital, Inc (NPI 1164486726)

Virginia Gay Hospital, Inc is a critical access hospital provider located in Vinton, Iowa. This profile covers 0 Medicare and 37 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	Virginia Gay Hospital, Inc
Address	502 N 9th Ave
City	Vinton
State	IA
ZIP	52349
Taxonomy	Critical Access Hospital
NPI Enumerated	April 12, 2006

Payer Source	Total Paid
Medicaid	$953.9K
Medicare	$0

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

37 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	1,810	$140	$244.9K
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.	1,480	$140	$206.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	4,990	$20	$114.9K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	2,740	$20	$57.5K
T1015	Clinic visit/encounter, all-inclusive	570	$90	$48.8K
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.	990	$50	$46.4K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	390	$100	$38.4K
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…	270	$100	$27.3K
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…	700	$40	$26.6K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	510	$50	$25.5K

Showing 1–10 of 37

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Iowa Distribution

Virginia Gay Hospital, Inc — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Iowa

Full comparison — all codes billed, vs. Iowa median

37 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	263	330	3,960	$170	$2.8M
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.	219	280	850	$140	$801.8K
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.	147	180	340	$170	$722K
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.	144	310	1,320	$100	$543.4K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	66	90	320	$120	$327.7K
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…	21	50	130	$320	$224.4K
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…	790	1,060	480	$40	$154.5K
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…	825	1,310	760	$20	$153.1K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	106	130	480	$30	$120.3K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	30	170	320	$20	$119.2K

Showing 1–10 of 37

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Virginia Gay Hospital, Inc	IA	Rural Health Clinic/Center	$0	$3.4M
Lee Birchansky	IA	Ophthalmology Physician	$593.9K	$0
Jonathan Rippentrop	IA	Urology Physician	$487.4K	$0
Thomas Richardson	IA	Urology Physician	$373K	$0
Gwen Behm	IN	Physician Assistant	$187.4K	$0
Fadi Yacoub	IA	Internal Medicine Physician	$183.3K	$0
Steven Mindrup	IA	Urology Physician	$174.8K	$0
Cassandra Lange	IA	Orthopaedic Surgery Physician	$153K	$0
Timothy Sagers	IA	Family Medicine Physician	$126.7K	$0
Kashif Chaudhry	NC	Clinical Cardiac Electrophysiology Physician	$96.5K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Luke's Jones Regional Medical Center	IA	Rural Health Clinic/Center	$0	$1.5M
Shawn Beilby	IA	Optometrist	$130.5K	$245.9K
Matthew Betterton	IA	Chiropractor	$40.9K	$121.9K
Maria Pitz	IA	Physical Therapist	$53.5K	$0
Jennifer Hoeger	IA	Speech-Language Pathologist	$26.3K	$0

Virginia Gay Hospital, Inc — Billing Profile & Reimbursement Data

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Virginia Gay Hospital, 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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