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.

Boone Memorial Hospital, Inc (NPI 1639135221)

Key Findings

Field	Value
Entity Type	Organization
Organization	Boone Memorial Hospital, Inc
Address	701 Madison Ave
City	Madison
State	WV
ZIP	25130
Taxonomy	Critical Access Hospital
NPI Enumerated	April 24, 2006

Payer Source	Total Paid
Medicaid	$31.9M
Medicare	$0

BOONE MEMORIAL HOSPITAL, INC reports no Medicare billing on file and $31.9M in lifetime Medicaid revenue, making its observable payer mix effectively single-payer (Medicaid) in the available data. The absence of Medicare revenue on file means analyses should treat Medicaid-driven utilization as the primary revenue and service signal for this provider.

Revenue concentration is high: the provider's top 3 Medicaid codes account for 35.8% of total Medicaid revenue, with 99285 generating $2.9M (12.7%), 99284 generating $2.7M (11.9%), and 87635 generating $2.5M (11.2%). This concentration indicates that a relatively small set of ED and respiratory testing services drives well over one-third of Medicaid income.

The code mix points to an acute care, emergency-department–centric operation supplemented by significant in-house laboratory capacity. High-revenue E/M codes 99285 (16.1K claims) and 99284 (19.4K claims) reflect sustained emergency-department throughput, while large volumes of respiratory molecular testing (87635, 15.8K claims) and multiplex respiratory panels (87631, 9.5K claims) show heavy diagnostic testing activity.

87635 and 87631 are state-level outliers for respiratory/COVID and multiplex respiratory testing respectively: 87635 ranks #3 of 87 providers in-state (98th percentile; extreme outlier, far above typical state volume for this code) and 87631 ranks #1 of 23 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code). Those positions indicate the provider is a major statewide hub for amplified nucleic acid respiratory testing relative to peers.

Emergency department E/M codes show above-average but not exceptional statewide standing: 99285 ranks #15 of 132 providers in-state (89th percentile; typical, unremarkable volume for this code) and 99284 ranks #25 of 168 providers in-state (86th percentile; typical, unremarkable volume for this code). In plain terms, the hospital has substantial ED activity compared with peers but is not a statistical extreme on ED E/M billing alone.

The facility also demonstrates notable volume for basic specimen collection and routine labs, implying significant outpatient or ED diagnostic throughput: 36415 has 46.2K claims and $507.7K revenue (ranks #13 of 328 providers in-state, 96th percentile; notably above typical state volume for this code), and 81000 has 20.1K claims and $362K revenue (ranks #2 of 14 providers in-state, 92th percentile; notably above typical state volume for this code). These patterns support the view of an active point-of-care and hospital lab operation handling large specimen volumes.

From a competitive standpoint within Medicaid, the provider combines high relative strength in respiratory molecular testing (extreme outlier positions) with robust but more typical ED volumes; this dual pattern suggests a locally important acute-care and diagnostic testing role rather than dominance across all service lines. Analysts should treat the provider as a regional acute-care hub with exceptional respiratory testing capacity, rather than a statewide leader across all high-revenue Medicaid codes.

The provider’s NPI was enumerated on 2006-04-24 (~20 years ago), indicating long-tenured presence in its market. That tenure, combined with concentrated Medicaid revenue tied to ED and lab services, suggests an established community hospital whose financial performance is closely linked to emergency care utilization and demand for respiratory/viral testing.

Medicaid: Complete Services Breakdown

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

212 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.	16,090	$180	$2.9M
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.	19,450	$140	$2.7M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	15,800	$160	$2.5M
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.	32,910	$50	$1.5M
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.	2,880	$500	$1.4M
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.	14,080	$90	$1.3M
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…	33,220	$30	$930.1K
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.	1,530	$590	$904.5K
87631	The lab analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus,…	9,490	$90	$891.9K
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.	2,050	$390	$804.5K

Showing 1–10 of 212

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

Boone Memorial Hospital, Inc — 3 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

212 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	274	390	4,610	$130	$2.2M
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.	15	130	2,090	$210	$1.5M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	31	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.	29	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.	25	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…	3	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.	31	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.	22	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.	52	110	2,080	$50	$537.1K
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…	36	50	800	$70	$504.4K

Showing 1–10 of 212

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Boone Memorial Hospital, Inc	WV	Rural Health Clinic/Center	$0	$11M
Boone Memorial Hospital, Inc	WV	Rural Health Clinic/Center	$0	$4.1M
Boone Memorial Hospital, Inc	WV	Multi-Specialty Clinic/Center	$0	$1.6M
Boone Memorial Hospital, Inc	WV	Rural Health Clinic/Center	$0	$1.6M
Boone Memorial Hospital, Inc	WV	Psychiatry Physician	$0	$873.5K
Matthew Hrastich	MO	Diagnostic Radiology Physician	$134.1K	$399.7K
Kalpesh Patel	AZ	Diagnostic Radiology Physician	$409.1K	$0
Mohamad Haffar	WV	Gastroenterology Physician	$274.4K	$0
Crysela Smith	TX	Diagnostic Radiology Physician	$249.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Womencare, Inc	WV	Federally Qualified Health Center (FQHC)	$0	$5.9M
Joseph Atkins	WV	Dentist	$0	$772.1K
Maria Gracely Meloy	WV	Physical Therapist	$107K	$0
Daniel Wright	WV	Foot & Ankle Surgery Podiatrist	$57.9K	$0
Howard Lafferty	WV	Family Medicine Physician	$57.2K	$0
Ronny Stollings	WV	Internal Medicine Physician	$6.5K	$0
Heather Robinson	WV	Physician Assistant	$5.4K	$0

Boone Memorial Hospital, 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