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 Healthcare Corporation (NPI 1447206370)

Carilion Healthcare Corporation is a multi-specialty clinic/center provider located in Roanoke, Virginia. This profile covers 0 Medicare and 201 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 Healthcare Corporation
Address	213 S Jefferson St Ste 1006
City	Roanoke
State	VA
ZIP	24011
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	May 25, 2006

Payer Source	Total Paid
Medicaid	$26.1M
Medicare	$0

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

201 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	156,050	$60	$10M
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…	191,060	$50	$9.9M
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…	10,700	$70	$738.4K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	7,080	$80	$580.8K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	5,010	$80	$375.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4,450	$80	$365.1K
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…	3,210	$100	$331K
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…	7,860	$40	$322.2K
0241U	N/A	1,920	$120	$238K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	5,410	$40	$210.9K

Showing 1–10 of 201

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 Healthcare Corporation — 9 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

201 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	106	400	1,910	$50	$412.6K
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.	277	400	2,060	$60	$407.3K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	45	150	300	$420	$381.2K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	27	210	920	$140	$367.6K
0241U	N/A	45	90	1,840	$80	$306.3K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	51	70	190	$570	$297K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	52	90	150	$520	$281.8K
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…	13	3,520	370	$70	$280.7K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	62	130	340	$110	$210.5K
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…	8	4,010	290	$50	$199.8K

Showing 1–10 of 201

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 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
Stonewall Jackson Memorial Hospital Company	WV	Rural Acute Care Hospital	$0	$13M
Carilion Rockbridge Community Hospital	VA	Critical Access Hospital	$0	$11.8M
Carilion Emergency Services, Inc.	VA	Urgent Care Clinic/Center	$0	$11.1M
Carilion Giles Community Hospital	VA	Critical Access Hospital	$0	$10.3M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jilda Long	VA	Optometrist	$314.3K	$3.1K
Jill Garrett	VA	Family Nurse Practitioner	$257.7K	$0
Alfonso Brochero	VA	Internal Medicine Physician	$214.3K	$2.5K
Gary Aragon	VA	Diagnostic Radiology Physician	$103.7K	$0

Carilion Healthcare Corporation — 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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