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.

Carilion Emergency Services, Inc. (NPI 1255602694)

Carilion Emergency Services, Inc. is a urgent care clinic/center provider located in Roanoke, Virginia. This profile covers 0 Medicare and 52 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	Carilion Emergency Services, Inc.
Address	1906 Belleview Ave Se
City	Roanoke
State	VA
ZIP	24014
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	January 17, 2012

Payer Source	Total Paid
Medicaid	$11.1M
Medicare	$0

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

52 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…	103,570	$60	$6.2M
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…	25,100	$80	$1.9M
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…	15,470	$80	$1.2M
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	10,830	$30	$368.1K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	18,360	$10	$238.7K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	18,070	$10	$234.9K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	7,730	$30	$231.9K
0241U	N/A	1,500	$120	$181.1K
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…	1,140	$110	$125K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	2,450	$30	$61.3K

Showing 1–10 of 52

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

Carilion Emergency Services, Inc. — 6 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

52 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
0241U	N/A	54	90	1,840	$80	$306.3K
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…	163	3,520	370	$70	$280.7K
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…	17	4,010	290	$50	$199.8K
94640	The provider administers oxygen under pressure or not under pressure to open obstructed air passages. He uses any of the listed devices to treat a patient with an acute obstruction of the airway that…	108	210	390	$50	$106.2K
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…	124	970	100	$100	$87.1K
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	1,000	100	$70	$81.1K
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…	44	90	380	$50	$76.5K
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,…	131	980	140	$70	$70.9K
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.	322	440	170	$30	$67.4K
12001	This CPT code is used for the simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet) that are 2.5 cm or less in…	69	80	170	$190	$66.8K

Showing 1–10 of 52

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carilion Medical Center	VA	General Acute Care Hospital	$0	$124.7M
Carilion Medical Center	VA	Multi-Specialty Clinic/Center	$0	$73.4M
Carilion New River Valley Medical Center	VA	General Acute Care Hospital	$0	$32.4M
Carilion Healthcare Corporation	VA	Multi-Specialty Clinic/Center	$0	$26.1M
Carilion Franklin Memorial Hospital	VA	General Acute Care Hospital	$0	$18.4M
Carilion Medical Center	VA	Emergency Medicine Physician	$0	$18.1M
Jefferson Radiology, PC	CT	Diagnostic Radiology Physician	$0	$14M
Carilion Rockbridge Community Hospital	VA	Critical Access Hospital	$0	$11.8M
Carilion Medical Center	VA	Home Health Agency	$0	$7.3M
Shaya Ansari	NY	Diagnostic Radiology Physician	$1.5M	$1K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carilion Clinic Patient Transportation, LLC	VA	Air Ambulance	$2.6M	$6.1M
Quest Diagnostics Clinical Laboratories Inc	VA	Clinical Medical Laboratory	$3.9M	$186.2K
Mark Kochenderfer	VA	Hematology & Oncology Physician	$2.5M	$0
Amanda Gillespie-twardy	VA	Hematology & Oncology Physician	$1.9M	$0
Suzan Merten	VA	Hematology & Oncology Physician	$1.8M	$90
Padmaja Mallidi	VA	Hematology & Oncology Physician	$1.7M	$0
Fairlawn Surgery Center, LLC	VA	Ambulatory Surgical Clinic/Center	$997K	$572.4K
Donald Vile	VA	Hematology & Oncology Physician	$1.4M	$0
Joshua Morales	VA	Hematology & Oncology Physician	$886.1K	$0
Matthew Skelton	VA	Hematology & Oncology Physician	$821.2K	$90

Carilion Emergency Services, 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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