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 1568461440)

Field	Value
Entity Type	Organization
Organization	Appalachian Regional Healthcare, Inc
Address	306 Stanaford Road
City	Beckley
State	WV
ZIP	25801
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 21, 2005

Payer Source	Total Paid
Medicaid	$18.3M
Medicare	$0

Key Findings

APPALACHIAN REGIONAL HEALTHCARE, INC reports no Medicare billing on file and $18.3M in lifetime Medicaid revenue, making its visible commercial/payer footprint in this dataset effectively single-payer (Medicaid) rather than balanced across Medicare and Medicaid. The absence of Medicare revenue suggests payer concentration risk in analyses that depend on Medicare exposure or Medicare-to-Medicaid comparisons.

Revenue concentration in Medicaid is high: the precomputed top 3 Medicaid codes (99284, 41899, 99285) together account for 37.5% of the provider's total Medicaid revenue, with individual shares of 14.2% (99284), 13.0% (41899), and 10.4% (99285). This concentration indicates that a relatively small set of services—chiefly emergency department E/M and a dental/oral procedure code—drive more than one-third of Medicaid revenue.

The code mix points to a hospital operating with a busy emergency department and substantial on-site procedural capabilities. High-volume ED E/M codes 99284 (15.8K claims, $112 avg paid/claim, $1.8M revenue) and 99285 (5.3K claims, $244 avg paid/claim, $1.3M revenue) together are major revenue contributors, while 41899 (1.6K claims, $1029 avg paid/claim, $1.6M revenue) implies a meaningful volume of oral/dentoalveolar procedures billed to Medicaid. These patterns are consistent with a General Acute Care Hospital that combines emergency services, procedural/dental work, and inpatient/observation throughput.

Competitive standing is mixed across codes: 41899 ranks #3 of 13 providers in-state (83th percentile; typical, unremarkable volume for this code), indicating a comparatively strong statewide position in that narrow procedural niche, while the ED codes 99284 and 99285 rank #26 of 168 (85th percentile) and #39 of 132 (71th percentile) respectively, reflecting typical to above-typical statewide ED volumes but not statewide dominance. Imaging and lab services such as 85025 (52.7K claims, $12 avg paid/claim, $632.5K revenue) and 80053 (41.9K claims, $14 avg paid/claim, $586.7K revenue) sit in the high-volume percentiles (91th and 88th percentiles respectively), supporting the view of substantial in-house diagnostic capacity.

Several CPT/HCPCS items are statistical outliers on utilization within the state dataset: 36415 (34.8K claims, $13 avg paid/claim, $452.3K revenue) ranks #18 of 328 providers (95th percentile; notably above typical state volume for this code), and 96372 (7.1K claims, $23 avg paid/claim, $162.2K revenue) ranks #18 of 309 providers (94th percentile; notably above typical state volume for this code). These high percentiles suggest unusually heavy volume for specimen collection and therapeutic injection services compared with peers, consistent with a high-throughput ED and ancillary services footprint.

Service-line detail beyond the ED is supported by imaging, observation, and procedure codes: G0378 Hospital observation service (1K claims, $430 avg paid/claim, $448.1K revenue) and 43239 endoscopic biopsy (1.2K claims, $342 avg paid/claim, $417.2K revenue) show material contributions to Medicaid revenue, while CT codes 74176 and 70450 and nuclear cardiology 78452 provide additional diagnostic revenue streams. Together these suggest care pathways that move patients from emergency evaluation through imaging, observation, and targeted procedures.

The provider’s tenure is long-standing in the NPI file: NPI enumerated 2005-07-21 (~21 years ago), indicating established operations in the market. This duration, combined with high-volume diagnostic and ED activity, suggests entrenched clinical workflows and capacity rather than a recently established facility.

From a payer/contracting perspective, the combination of no Medicare billing and $18.3M in Medicaid revenue implies contracting and reimbursement analyses should focus on Medicaid rates, utilization controls, and state-level competitive dynamics; the top-3 concentration (37.5% of Medicaid revenue) and high-volume lab/ED codes (e.g., 85025, 80053, 36415) are critical levers for forecasting and negotiations with this provider.

Medicaid: Complete Services Breakdown

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

256 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	15,780	$110	$1.8M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	1,570	$1,030	$1.6M
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.	5,290	$240	$1.3M
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.	15,320	$70	$1.1M
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	52,710	$10	$632.5K
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.	41,910	$10	$586.7K
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.	11,570	$50	$520.7K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	34,790	$10	$452.3K
G0378	Hospital observation service, per hour	1,040	$430	$448.1K
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…	7,110	$60	$440.8K

Showing 1–10 of 256

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 — 0 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

256 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	39	130	2,090	$210	$1.5M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	3	10	580	$1,120	$1.3M
G0482	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…	14	20	1,050	$80	$1.3M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	43	40	820	$30	$1.2M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	43	40	820	$30	$1.2M
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.	26	170	3,350	$120	$1.1M
88175	The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer…	17	20	70	$20	$832.7K
87624	The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result.	20	20	720	$20	$721.7K
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.	26	160	3,690	$80	$714.8K
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.	50	80	950	$140	$559.5K

Showing 1–10 of 256

Related Providers

Other providers that share a Tax Identification Number (TIN) with Appalachian Regional Healthcare, Inc, ranked by combined Medicare and Medicaid revenue.

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.	KY	Critical Access Hospital	$0	$17.9M
Mercy Health System Corporation	WI	Multi-Specialty Clinic/Center	$0	$13.2M

Nearby Providers

Other providers in the same ZIP code as Appalachian Regional Healthcare, Inc, ranked by combined Medicare and Medicaid revenue.

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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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