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.

York Hospital (NPI 1326060492)

Field	Value
Entity Type	Organization
Organization	York Hospital
Address	1001 S George St
City	York
State	PA
ZIP	17403
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 24, 2006

Payer Source	Total Paid
Medicaid	$40.7M
Medicare	$0

Key Findings

YORK HOSPITAL reports $40.7M in lifetime Medicaid revenue and has no Medicare billing on file, making its billing profile effectively single-payer Medicaid in scope for the available data. This absence of Medicare activity contrasts with the material Medicaid footprint and means analysts should treat Medicaid as the dominant revenue stream for payer-mix and contracting analysis.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 53.8% of the provider's total Medicaid revenue. Those top three are 99285 ($8.2M, 26.7%), U0003 ($5.1M, 16.5%), and 99283 ($3.2M, 10.6%); together they define the majority of the hospital’s Medicaid revenue base.

The code mix points to an emergency-department–centric operation with extensive diagnostic and testing throughput. High-revenue ED E/M codes (99285, 99284, 99283) plus hospital observation service G0378 ($2.2M, 7.2%) and a very large volume of clinic encounter code T1015 (51.6K claims, $2.1M) indicate the hospital runs a high-volume ED/observation and ambulatory evaluation workflow.

99285 is a clear competitive outlier for this provider in-state: it ranks #12 of 1228 providers in Pennsylvania (99th percentile; extreme outlier), signaling that YORK HOSPITAL is a major destination for high-acuity ED visits relative to peers. Similarly, 99283 ranks #34 of 1063 (97th percentile; notably above typical state volume), reinforcing a broad ED mix across acuity levels.

U0003 (SARS‑CoV‑2 nucleic acid testing) is another concentration point: 57.5K claims and $5.1M revenue, ranking #5 of 197 providers in-state (98th percentile; notably above typical state volume). Coupled with other high-volume lab and PLA codes such as 0241U (5.8K claims, $473.5K, rank #5 of 191, 98th percentile) and 0202U (2.2K claims, $322K, rank #11 of 55), the profile shows significant institutional investment in high-throughput infectious-disease and specialized laboratory testing.

Several individual codes are flagged as extreme outliers in statewide ranking, indicating exceptional throughput in specific operational areas: 36415 (103.4K claims, rank #3 of 675, 100th percentile; extreme outlier) and 84702 (16.8K claims, rank #2 of 159, 99th percentile; extreme outlier) point to very large specimen-collection and pregnancy-testing volumes, while 93005 (28.9K claims, rank #5 of 220, 98th percentile; extreme outlier) shows outsized ECG testing volume. These patterns suggest both high patient flow and centralized lab/diagnostic capacity.

Operational indicators of scale are evident in raw claim counts across diagnostic and routine services: 69.4K claims for 85025 (CBC), 103.4K claims for 36415 (blood draw), and 51.6K claims for T1015 (clinic visit) support the view of a high-throughput facility handling large ambulatory and ED caseloads. Analysts should interpret cost and utilization metrics in light of this throughput when benchmarking utilization, staffing, and lab capacity.

YORK HOSPITAL’s NPI has been enumerated since 2006-07-24 (~20 years ago), indicating a long-tenured provider presence in the market. Combined with its Medicaid-centric revenue and multiple statewide rank outliers, this tenure suggests established operational scale in emergency, observation, and lab/testing services rather than a recently scaled operation.

Medicaid: Complete Services Breakdown

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

540 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	44,930	$180	$8.2M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	57,520	$90	$5.1M
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.	24,200	$130	$3.2M
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.	21,140	$140	$3M
G0378	Hospital observation service, per hour	2,600	$850	$2.2M
T1015	Clinic visit/encounter, all-inclusive	51,620	$40	$2.1M
81513	The lab analyst performs the technical lab test on a vaginal fluid specimen for quantitative real–time amplification of RNA markers for three bacterial species listed in the code descriptor, and…	5,290	$110	$555.5K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	19,350	$30	$503K
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.	47,990	$10	$479.9K
0241U	N/A	5,850	$80	$473.5K

Showing 1–10 of 540

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

York Hospital — 17 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

540 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1745	Injection, infliximab, excludes biosimilar, 10 mg	15	20	350	$1,720	$1.6M
G0378	Hospital observation service, per hour	25	150	510	$870	$1.4M
T1015	Clinic visit/encounter, all-inclusive	62	1,690	760	$170	$1.2M
J9271	Injection, pembrolizumab, 1 mg	24	20	420	$1,230	$827.7K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	17	130	310	$60	$769.3K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	30	210	730	$40	$689.7K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	5	200	990	$70	$517.5K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	40	410	1,130	$60	$455.4K
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.	62	1,600	270	$120	$409.7K
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.	34	1,060	150	$130	$405.4K

Showing 1–10 of 540

Related Providers

Other providers that share a Tax Identification Number (TIN) with York Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wellspan Medical Group	PA	Psychiatry Physician	$0	$22.3M
Wellspan Medical Group	PA	Pediatrics Physician	$0	$9.9M
York Hospital	PA	Family Medicine Physician	$0	$6.2M
York Hospital	ME	General Acute Care Hospital	$0	$5.8M
Gregory Fazio	PA	Clinical Cardiac Electrophysiology Physician	$214.3K	$370
Vanessa Millsaps	PA	Family Nurse Practitioner	$155.2K	$0
Kevin Mccullum	PA	Cardiovascular Disease Physician	$130.7K	$10.5K
Michelle Consolini	PA	Cardiovascular Disease Physician	$129K	$10.9K
Fadi Habib	PA	Anatomic Pathology & Clinical Pathology Physician	$131.8K	$0
Shubha Acharya	PA	Internal Medicine Physician	$113.5K	$0

Nearby Providers

Other providers in the same ZIP code as York Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Family First Health Corporation	PA	Federally Qualified Health Center (FQHC)	$0	$6.4M
Haiyun Wang	PA	Hematology & Oncology Physician	$2M	$0
Joyce Huang	PA	Hematology & Oncology Physician	$1.7M	$0
Joseph Kannarkatt	PA	Hematology & Oncology Physician	$1.7M	$0
Chanh Huynh	PA	Hematology & Oncology Physician	$1.4M	$430
Dan Sotirescu	PA	Hematology & Oncology Physician	$1.4M	$0
Apple Hill Surgical Center Partners	PA	Ambulatory Surgical Clinic/Center	$996.2K	$283.1K
Daniel Efiom-ekaha	PA	Hematology & Oncology Physician	$1.2M	$0
Creston Tate	PA	Family Medicine Physician	$18.1K	$1.1M
Grigori Okoev	PA	Hematology & Oncology Physician	$905.2K	$0

York Hospital — Billing Profile & Reimbursement Data

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York Hospital — 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