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.

Raleigh General Hospital LLC (NPI 1629015698)

Key Findings

Field	Value
Entity Type	Organization
Organization	Raleigh General Hospital LLC
Address	1710 Harper Rd
City	Beckley
State	WV
ZIP	25801
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 31, 2006

Payer Source	Total Paid
Medicaid	$36.4M
Medicare	$0

This provider is effectively single‑payer in the Medicare/Medicaid mix: there is no Medicare billing on file while total Medicaid revenue is $36.4M, so Medicaid dominates the hospital’s reimbursed activity and financial footprint in the available claims data. That concentration means analyses of utilization and reimbursement risk should be interpreted through a Medicaid lens rather than a mixed‑payer perspective.

Medicaid revenue is highly concentrated in emergency department E/M codes: 99285 (16K claims, $343 avg paid/claim, $5.5M revenue, 21.6%), 99284 (32.9K claims, $138 avg paid/claim, $4.5M revenue, 17.9%), and 99283 (26.1K claims, $85 avg paid/claim, $2.2M revenue, 8.8%) together account for 48.2% of the provider’s total Medicaid revenue. Those three codes drive nearly half of Medicaid dollars reported and indicate that ED evaluation and management is the single largest revenue stream for this facility.

The code mix and volumes point to a high-throughput emergency department with linked observation and procedure capacity: G0378 (hospital observation service) appears with 6.4K claims and $1.1M revenue (4.3%), and the three top E/M codes above show heavy claim counts. This pattern—high counts for 99284/99283/99285 plus observation hours—suggests the hospital operates a busy ED that funnels patients into short‑term observation rather than elective Medicare-era inpatient pathways (consistent with no Medicare billing on file).

Laboratory and specimen services represent another major operational axis: 85027 (59.8K claims, $19 avg paid/claim, $1.1M revenue, ranks #1 of 71 in-state) is marked as an extreme outlier, far above typical state volume for this code, and 36415 (59K claims, $19 avg paid/claim, $1.1M revenue, ranks #7 of 328) is noted as notably above typical state volume. These exceptionally high phlebotomy and CBC claim counts indicate heavy routine diagnostic throughput that supports both ED and inpatient workflows and could be a strategic leverage point for laboratory contracting or capacity planning.

The hospital provides advanced imaging and invasive cardiology imaging services alongside routine diagnostics: 93458 (1K claims, $1275 avg paid/claim, $1.3M revenue, ranks #5 of 25) and 78452 (1.7K claims, $538 avg paid/claim, $907.6K revenue) indicate cath lab imaging and nuclear cardiology capacity, while CT and other imaging codes such as 74177 (4.6K claims, $147 avg paid/claim, $673.8K) and 70450 (7.1K claims, $53 avg paid/claim, $378.6K) support cross-sectional and neuroimaging services. The presence of these higher-acuity imaging codes shows capability beyond a basic community ED and aligns with the taxonomy of a General Acute Care Hospital.

Procedural and surgical activity is present but less revenue‑dominant than ED and diagnostics: 11042 (4.6K claims, $84 avg paid/claim, $389.6K revenue) ranks #3 of 44 in-state and is flagged as notably above typical state volume, and 47562 (98 claims, $3777 avg paid/claim, $370.1K revenue) shows episodic higher‑value surgical cases (laparoscopic cholecystectomy). Together these findings indicate the hospital performs a meaningful volume of operative and wound care procedures that complement its ED and observation workload.

Competitive standing is mixed across service lines: the hospital is a state leader in routine lab volumes (85027 rank #1 of 71, 100th percentile; extreme outlier) and shows notably above typical state volume for phlebotomy and several procedure codes (36415 98th percentile; 11042 95th percentile; 84702 97th percentile), while several high‑acuity ED codes are described as typical or unremarkable despite high absolute claim counts (for example, 99285 ranks #16 of 132, 89th percentile, described as typical, unremarkable). With an NPI enumerated on 2006-05-31 (~20 years ago) the provider appears to be an established, regionally active acute care hospital with particular strengths in ED throughput and diagnostic laboratory services rather than a broad, high‑Medicare specialist center.

Medicaid: Complete Services Breakdown

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

271 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.	15,970	$340	$5.5M
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.	32,940	$140	$4.5M
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.	26,150	$90	$2.2M
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…	1,000	$1,280	$1.3M
85027	The lab analyst performs a blood count on the red and white blood cells and platelets also known as thrombocytes. He also determines the hemoglobin, typically by spectrophotometry, and the…	59,820	$20	$1.1M
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	59,030	$20	$1.1M
G0378	Hospital observation service, per hour	6,390	$170	$1.1M
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…	1,690	$540	$907.6K
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.	44,380	$20	$798.8K
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.	4,580	$150	$673.8K

Showing 1–10 of 271

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

Raleigh General Hospital LLC — 4 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

271 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.	16	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.	9	10	580	$1,120	$1.3M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	25	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.	25	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.	15	170	3,350	$120	$1.1M
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…	10	30	180	$40	$773.3K
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.	16	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.	19	80	950	$140	$559.5K
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.	39	110	2,080	$50	$537.1K
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.	136	140	790	$90	$469.7K

Showing 1–10 of 271

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Raleigh General Hospital LLC	WV	Internal Medicine Physician	$0	$2.1M
Raleigh General Hospital LLC	WV	Gastroenterology Physician	$0	$915.1K
Barry Vaught	WV	Neurology Physician	$459.4K	$0
Andrew Thymius	WV	Interventional Pain Medicine Physician	$199.7K	$0
Mitchell Rashid	WV	Interventional Cardiology Physician	$171.2K	$0
Elie Gharib	WV	Interventional Cardiology Physician	$162.3K	$0
John Tabit	WV	Orthopaedic Trauma Physician	$143.3K	$0
Angela Dolganiuc	WV	Gastroenterology Physician	$142.3K	$0
Charles Porterfield	WV	Pulmonary Disease Physician	$97.5K	$0
Blake Weeks	NC	Foot & Ankle Surgery Podiatrist	$96.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
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
Appalachian Regional Healthcare, Inc	WV	General Acute Care Hospital	$0	$18.3M
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

Raleigh General Hospital LLC — 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