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.

Valley Health Care, Inc. (NPI 1659720464)

Field	Value
Entity Type	Organization
Organization	Valley Health Care, Inc.
Address	100 Bell Street
City	Elkins
State	WV
ZIP	26241
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	June 13, 2016

Payer Source	Total Paid
Medicaid	$778.8K
Medicare	$0

Medicaid: Complete Services Breakdown

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	4,110	$190	$775.8K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	430	$1	$1.7K
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,…	700	$1	$700
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	20	$30	$560
86580	The lab analyst performs an intradermal skin test on a patient to test for tuberculosis.	40	$0	$0
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	40	$0	$0
87430	The lab analyst performs an assay to evaluate the patient’s sample for antigens to Streptococcus, group A, using an immunoassay method, such as EIA.	40	$0	$0
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	30	$0	$0
90656	This code represents a preservative–free trivalent influenza vaccine product containing split virus components. It is administered into the muscle in a 0.5 mL dosage.	10	$0	$0
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	150	$0	$0

Showing 1–10 of 15

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

Valley Health Care, Inc. — 0 of 4 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

15 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	205	390	4,610	$130	$2.2M
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…	515	1,270	1,240	$30	$245K
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,…	202	540	320	$20	$43.2K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	175	190	190	$30	$35.9K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	70	90	190	$20	$26K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	282	330	320	$20	$24.4K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	158	430	200	$10	$18.3K
87430	The lab analyst performs an assay to evaluate the patient’s sample for antigens to Streptococcus, group A, using an immunoassay method, such as EIA.	26	40	200	$10	$17.5K
92551	The provider delivers a limited series of tones or sounds to a patient to determine if the patient’s hearing is in an acceptable range to detect hearing problems.	91	130	110	$10	$10.6K
G2023	Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source	46	60	180	$10	$8.6K

Showing 1–10 of 15

Related Providers

Other providers that share a Tax Identification Number (TIN) with Valley Health Care, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Valley Health Care, Inc	WV	Federally Qualified Health Center (FQHC)	$0	$7.6M
Valley Health Care, Inc	WV	Federally Qualified Health Center (FQHC)	$0	$5.4M
Jenna Gongola	WV	Optometrist	$50.9K	$0
Debra Auble	WV	Family Medicine Physician	$4.2K	$0
Michelle Ratnakar	WV	Physician Assistant	$500	$0

Nearby Providers

Other providers in the same ZIP code as Valley Health Care, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Select In Home Services, Inc.	WV	Personal Care Attendant	$0	$25.7M
Davis Memorial Hospital	WV	General Acute Care Hospital	$0	$20.1M
Ems, Inc.	WV	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$17.6M
Mountaineer Home Care Services LLC	WV	In Home Supportive Care Agency	$0	$12.4M
Youth Health Service, Inc	WV	Community/Behavioral Health Agency	$0	$9.8M
Appalachian Community Health Center	WV	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$8.6M
Wendy Collins	WV	Homemaker	$0	$7.6M
Randolph County Court Emergency Squad	WV	Land Ambulance	$1M	$5.3M
Drs Wilson And Martino Of Elkins	WV	General Practice Dentistry	$0	$5.8M
Alternative Home Care LLC	WV	Homemaker	$0	$5.1M

Valley Health Care, Inc. — Billing Profile & Reimbursement Data

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Valley Health Care, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References