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

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

Valley Hospital Medical Center (NPI 1417947490)

Key Findings

Field	Value
Entity Type	Organization
Organization	Valley Hospital Medical Center
Address	620 Shadow Ln
City	Las Vegas
State	NV
ZIP	89106
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 21, 2005

Payer Source	Total Paid
Medicaid	$47M
Medicare	$0

This provider is effectively a Medicaid-focused hospital: total Medicaid revenue is $47M and there is no Medicare billing on file, so Medicaid entirely dominates recorded payer activity for VALLEY HOSPITAL MEDICAL CENTER. The NPI was enumerated 2005-10-21 (~21 years ago), indicating an established operating presence in LAS VEGAS for about two decades.

Revenue is highly concentrated in emergency and observation codes: the precomputed top three Medicaid codes account for 46.1% of the provider's total Medicaid revenue, led by 99285 ($9M, 23.6% of Medicaid revenue), G0378 ($5M, 13.1%), and 99284 ($3.6M, 9.5%). This concentration signals that a large share of the hospital’s Medicaid dollars are driven by high-acuity emergency department evaluations and hospital observation hours.

The claims volume and code mix point to a high-throughput ED with integrated observation, imaging, and procedural support. Emergency visit code 99285 shows 82.2K claims and ranks #6 of 352 in-state (99th percentile; notably above typical state volume), observation code G0378 has 44.8K claims and ranks #2 of 38 (97th percentile; notably above typical state volume), and 99284 has 38.6K claims, reinforcing that acute ED services are the core service line.

Infusion and medication administration are unusually prominent relative to peers: 96375 (53.8K claims) ranks #1 of 72 providers in-state (100th percentile; extreme outlier, far above typical state volume), 96361 (45.3K claims, $1M) ranks #2 of 58 (98th percentile; extreme outlier), and 96374 (56.1K claims) ranks #4 of 79 (96th percentile; notably above typical state volume). These patterns indicate heavy use of IV push/infusion treatments in the hospital setting.

Imaging and diagnostic throughput is a meaningful secondary revenue driver tied to the ED profile: CT abdomen/pelvis with contrast 74177 generates $3.2M (12.6K claims) and ranks #9 of 137 (94th percentile; typical, unremarkable volume), while CT head 70450 has 20.5K claims and $2.2M revenue (5.7%) and ranks #7 of 155 (96th percentile; typical, unremarkable volume). The presence of CTA chest 71275 ($1.3M) and multiple spine CT codes shows substantial cross-sectional imaging support for emergency presentations.

Laboratory and cardiac monitoring volumes are very high in absolute terms and elevated vs. peers: CBC 85025 records 130.9K claims ($392.8K) and ranks #5 of 157 (97th percentile; notably above typical state volume), troponin 84484 has 70.7K claims ($282.6K) and ranks #2 of 70 (99th percentile; extreme outlier, far above typical state volume), and EKG-only service 93005 shows 68.6K claims ($274.3K) and ranks #3 of 73 (97th percentile; notably above typical state volume). This supports characterization of a busy ED with high diagnostic throughput.

Several procedure codes tied to wound care and debridement are also unusually concentrated: 11042 (10.9K claims, $511.3K) ranks #2 of 52 providers in-state (98th percentile; extreme outlier, far above typical state volume), suggesting a larger-than-typical procedural caseload for skin/subcutaneous debridement in the Medicaid population. Combined with the high ED and imaging volumes, this points to integrated acute procedural capacity on-site.

Collectively, statewide competitive standing is strong for ED-associated services: multiple high-volume codes rank in the 94th–100th percentiles (examples include 99285 at the 99th percentile and 96375 at the 100th percentile), indicating VALLEY HOSPITAL MEDICAL CENTER is a major in-state provider for emergency evaluation, observation services, IV medication/infusion administration, and related diagnostic testing.

Medicaid: Complete Services Breakdown

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

324 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.	82,160	$110	$9M
G0378	Hospital observation service, per hour	44,820	$110	$5M
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.	38,580	$90	$3.6M
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.	12,600	$250	$3.2M
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.	20,540	$110	$2.2M
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.	34,430	$50	$1.8M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	8,570	$200	$1.7M
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	2,720	$490	$1.3M
71275	In this procedure, the provider performs a computed tomographic angiography, or CTA imaging of the chest to get detailed images of the blood vessels but not the heart. He performs this study using a…	4,570	$280	$1.3M
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.	51,200	$20	$1.1M

Showing 1–10 of 324

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nevada Distribution

Valley Hospital Medical Center — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nevada

Full comparison — all codes billed, vs. Nevada median

324 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0378	Hospital observation service, per hour	2	40	4,770	$110	$1.2M
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.	6	350	240	$110	$685.4K
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.	18	400	200	$90	$442.5K
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.	9	140	210	$140	$421K
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.	40	310	680	$50	$373.3K
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…	8	60	680	$60	$364.3K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	37	90	190	$160	$332.4K
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.	18	390	200	$60	$289.8K
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	13	30	290	$60	$260.3K
71275	In this procedure, the provider performs a computed tomographic angiography, or CTA imaging of the chest to get detailed images of the blood vessels but not the heart. He performs this study using a…	5	60	330	$150	$250.4K

Showing 1–10 of 324

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Laboratory Corporation Of America Holdings	NC	Clinical Medical Laboratory	$214.6M	$1.4B
Laboratory Corporation Of America Holdings	NJ	Clinical Medical Laboratory	$143.3M	$717.5M
Natera, Inc.	CA	Clinical Medical Laboratory	$133.1M	$641.5M
Unilab Corporation	CA	Clinical Medical Laboratory	$94M	$668.5M
Bioreference Health, LLC	NJ	Clinical Medical Laboratory	$66.8M	$620.1M
Laboratory Corporation Of America Holdings	OH	Clinical Medical Laboratory	$56.9M	$617M
Millennium Health, LLC	CA	Clinical Medical Laboratory	$20.4M	$579.3M
Exact Sciences Laboratories, LLC	WI	Clinical Medical Laboratory	$299.3M	$276.5M
Aeroflow Inc.	NC	Durable Medical Equipment & Medical Supplies	$0	$571.9M
Zoll Services LLC	PA	Durable Medical Equipment & Medical Supplies	$0	$503.8M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Clark County Department Of Family Services	NV	Case Management Agency	$0	$166.5M
Shadow Emergency Physicians PLLC	NV	Emergency Medicine Physician	$0	$75.2M
Southwest Medical Associates, Inc	NV	Diagnostic Radiology Physician	$418.3K	$15.8M
Las Vegas Paiute Tribe Health & Human Services	NV	General Practice Physician	$0	$13.6M
Fresenius Medical Care West Sahara, LLC	NV	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$12.2M
Bridge Counseling Associates, Inc	NV	Community/Behavioral Health Agency	$0	$12.1M
Iriye Medical Group PLLC	NV	Maternal & Fetal Medicine Physician	$0	$11.9M
Janda, Mahajan & Balsiger PLLC	NV	Neurology Physician	$0	$10.5M
Behavioral Health Institute Inc (singh) PC	NV	Addiction Medicine (Family Medicine) Physician	$0	$9.8M
Pulmonary Associates, Inc.	NV	Pulmonary Disease Physician	$0	$8.5M

Valley Hospital Medical Center — 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