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

Why is the Medicaid comparison limited to West 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. West 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.

Appalachian Regional Healthcare, Inc (NPI 1477510162)

Appalachian Regional Healthcare, Inc is a family medicine physician provider located in Beckley, West Virginia. This profile covers 0 Medicare and 71 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	Appalachian Regional Healthcare, Inc
Address	250 Stanaford Rd
City	Beckley
State	WV
ZIP	25801
Taxonomy	Family Medicine Physician
NPI Enumerated	April 27, 2006

Payer Source	Total Paid
Medicaid	$6.3M
Medicare	$0

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

71 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…	34,490	$50	$1.8M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	44,160	$30	$1.1M
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…	23,190	$40	$904.4K
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…	4,800	$90	$451.1K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	6,080	$60	$365K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	3,010	$80	$246.5K
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…	3,480	$60	$219.4K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	10,460	$20	$198.7K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	4,160	$40	$174.5K
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.	1,410	$80	$105.8K

Showing 1–10 of 71

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Appalachian Regional Healthcare, Inc — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

71 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	96	1,270	1,240	$30	$245K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	6	190	660	$40	$226.4K
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…	20	1,030	890	$50	$221K
93458	In this procedure, the provider performs imaging supervision and interpretation for a coronary angiography with left heart catheterization and intraprocedural injections for left ventriculography. He…	9	30	130	$490	$213.5K
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…	15	60	170	$130	$189.3K
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.	19	70	530	$170	$183.7K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	14	80	580	$60	$182K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	179	310	740	$80	$178.2K
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…	36	100	550	$80	$164.8K
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…	38	60	330	$210	$151.7K

Showing 1–10 of 71

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$107.9M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$55.1M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$38.9M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$33.4M
Union Associated Physicians Clinic, LLC	IN	Family Medicine Physician	$0	$31.1M
Appalachian Regional Healthcare, Inc.	KY	Critical Access Hospital	$0	$26.9M
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$26.8M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Appalachian Regional Healthcare, Inc	WV	General Acute Care Hospital	$0	$18.3M
Appalachian Regional Healthcare, Inc.	KY	Critical Access Hospital	$0	$17.9M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Raleigh General Hospital LLC	WV	General Acute Care Hospital	$0	$36.4M
Community Health Systems, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$35M
Fmrs Health Systems Inc	WV	Community/Behavioral Health Agency	$0	$27M
Health Care Alliance, Inc.	WV	Emergency Medicine Physician	$0	$25M
Jan-care Ambulance Of Raleigh County Inc	WV	Land Ambulance	$1.9M	$20.8M
Raleigh County Commission On Aging, Inc.	WV	Home Health Agency	$0	$16.7M
Mountain State Home Health Care Inc	WV	Nursing Care Agency	$0	$16.5M
Family Options Providers, LLC.	WV	Community/Behavioral Health Agency	$0	$16.1M
Raleigh County Commission On Aging, Inc.	WV	Home Health Agency	$0	$13.8M
Community Health Systems, Inc.	WV	Obstetrics & Gynecology Physician	$0	$11.9M

Appalachian Regional Healthcare, Inc — Billing Profile & Reimbursement Data

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Appalachian Regional Healthcare, 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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