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.

Bali Surgical Practice PLLC (NPI 1659419653)

Bali Surgical Practice PLLC is a surgery physician provider located in Charleston, West Virginia. This profile covers 0 Medicare and 22 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	Bali Surgical Practice PLLC
Address	400 Court St Ste 203
City	Charleston
State	WV
ZIP	25301
Taxonomy	Surgery Physician
NPI Enumerated	February 2, 2007

Payer Source	Total Paid
Medicaid	$3.9M
Medicare	$0

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

22 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	63,840	$40	$2.8M
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…	7,300	$40	$306.7K
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…	3,660	$60	$223.3K
S2083	Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline	1,030	$130	$133.3K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	11,720	$10	$117.2K
76942	Ultrasonography uses sound waves of higher frequencies (above the normal hearing capacity of a healthy human, i.e., 20 kHz) to visualize inner organs. When the sound waves pass through the human…	1,520	$50	$68.4K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	2,490	$30	$62.3K
99401	At an encounter separate from a preventive medicine visit, the provider offers counseling related to subjects appropriate for the patient’s age, family history, and areas of concern. The subjects…	3,130	$20	$53.3K
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.	560	$90	$47.9K
Q3014	Telehealth originating site facility fee	1,550	$20	$31K

Showing 1–10 of 22

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

Bali Surgical Practice PLLC — 2 of 21 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

22 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	2	30	1,020	$50	$438.2K
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…	262	1,270	1,240	$30	$245K
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…	236	1,030	890	$50	$221K
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.	34	70	530	$170	$183.7K
S2083	Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline	1	10	1,030	$130	$133.7K
Q3014	Telehealth originating site facility fee	30	80	580	$20	$104.1K
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…	130	340	140	$90	$97.5K
76705	An abdominal ultrasound is a noninvasive procedure used to assess the body parts within the abdomen (i.e. liver, gallbladder, pancreas, bile ducts, spleen, and abdominal aorta). This particular code…	50	70	480	$40	$78.7K
99402	At an encounter separate from a preventive medicine visit, the provider offers counseling related to subjects appropriate for the patient’s age, family history, and areas of concern. The subjects…	4	10	590	$40	$46.6K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	93	540	320	$20	$43.2K

Showing 1–10 of 22

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Charleston Area Medical Center Inc	WV	General Acute Care Hospital	$0	$200.1M
Wv Birth To Three	WV	Early Intervention Provider Agency	$0	$59.9M
Charleston Area Medical Center, Inc.	WV	General Acute Care Hospital	$0	$50.9M
Children's Home Society Of West Virginia	WV	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$44.1M
Kanawha County Emergency Ambulance Authority	WV	Land Ambulance	$2.3M	$31.9M
Maxim Healthcare Services, Inc.	WV	Home Health Agency	$0	$19.9M
All-aid Services, Inc.	WV	Home Health Agency	$0	$16.3M
The Arc Of The Three Rivers, Inc.	WV	Case Management Agency	$0	$15.6M
Retina Consultants, PLLC	WV	Retina Specialist (Ophthalmology) Physician	$0	$13.6M
Dolan & Kalaskey Ltd	WV	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$8.3M

Bali Surgical Practice PLLC — Billing Profile & Reimbursement Data

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Bali Surgical Practice PLLC — 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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