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 Virginia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to 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. 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.

Carilion Medical Center (NPI 1730123472)

Key Findings

Field	Value
Entity Type	Organization
Organization	Carilion Medical Center
Address	1906 Belleview Ave Se
City	Roanoke
State	VA
ZIP	24014
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	June 15, 2006

Payer Source	Total Paid
Medicaid	$73.4M
Medicare	$0

CARILION MEDICAL CENTER is effectively a single-payer Medicaid billing entity: Medicare billing on file is listed as none while total Medicaid revenue is $73.4M, so the provider’s financial footprint in the dataset is driven entirely by Medicaid activity rather than a split payer mix. This makes Medicaid reimbursement performance and state-level comparisons the primary lens for analyzing its billing profile.

Revenue is highly concentrated in a small set of evaluation-and-management codes: the precomputed top three Medicaid codes (99214, 99213, 99232) account for 49.0% of the provider's total Medicaid revenue. Individually, 99214 generated $14.9M (24.9% of Medicaid revenue), 99213 generated $10.3M (17.2%), and 99232 generated $4.1M (6.9%), indicating that office/outpatient E/M and subsequent inpatient visits are the main revenue drivers.

The code mix signals a combined high-volume outpatient practice with substantial inpatient and hospital-based services. High volumes of 99214 (201.5K claims) and 99213 (194.6K claims) point to heavy ambulatory care throughput, while large counts for inpatient/subsequent care codes such as 99232 (103.7K claims), 99233 (73.7K claims) and initial inpatient codes 99223/99222 show significant hospital-based evaluation & management activity. This pattern is consistent with a multi-specialty clinic/center that operates both outpatient clinics and admits or bills for inpatient encounters.

CARILION ranks as a dominant statewide provider for many high-volume E/M codes: 99214 ranks #9 of 3523 providers in-state (100th percentile; extreme outlier) and 99213 ranks #7 of 4012 providers in-state (100th percentile; extreme outlier). Several hospital E/M and procedural codes also sit at top state percentiles (for example, 99232 ranks #4 of 398, 99233 ranks #3 of 285), which collectively characterizes the provider as a major Medicaid player in Virginia across both clinic and inpatient service lines.

Beyond routine E/M, the provider shows notable high-acuity and specialty activity. Critical care billing 99291 produced $1.1M (11.1K claims) and ranks #5 of 134 providers in-state (97th percentile; notably above typical state volume), while initial inpatient visits such as 99223 generated $2.1M and rank #4 of 284 (99th percentile; extreme outlier). These entries indicate an operational capacity to deliver and bill for higher-acuity inpatient and critical care services under Medicaid.

Cardiac imaging and obstetric services are material secondary revenue streams. 93306 (echocardiography) appears with 24.1K claims and $1.3M revenue, ranking #3 of 211 providers in-state (99th percentile; extreme outlier), and obstetric/ultrasound codes like 76816 and 76811 show elevated volumes and state ranks (76816: 15.1K claims, $1.2M, rank #3 of 142; 76811: 5.9K claims, $845.7K, rank #3 of 61). This mix suggests significant on-site diagnostic imaging and maternal-fetal services supporting the clinical footprint.

Preventive and pediatric services are also concentrated at above-typical state volumes: 99392 ($1.4M, 16.3K claims) ranks #7 of 646 providers (99th percentile; extreme outlier) and 99393 ($692.7K, 8.3K claims) ranks #14 of 627 providers (98th percentile; extreme outlier). These entries indicate that routine well visits and preventive care for both adults and children contribute meaningfully to Medicaid revenue alongside high-volume adult outpatient care.

The provider’s NPI has been enumerated since 2006-06-15 (~20 years ago), evidencing long tenure in the market. Combined with the large claim volumes, high state ranks across multiple service lines, and $73.4M in Medicaid revenue, this longevity supports an interpretation of CARILION MEDICAL CENTER as an established, high-volume Medicaid provider with integrated ambulatory, inpatient, imaging, obstetric, and critical-care billing activity in Virginia.

Medicaid: Complete Services Breakdown

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

357 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	201,460	$70	$14.9M
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…	194,580	$50	$10.3M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	103,690	$40	$4.1M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	73,750	$50	$4M
G9012	Other specified case management service not elsewhere classified	12,900	$240	$3.1M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	22,150	$120	$2.6M
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…	19,650	$110	$2.2M
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	21,030	$100	$2.1M
J0585	Injection, onabotulinumtoxina, 1 unit	2,550	$630	$1.6M
99203	The provider sees a new 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 provider…	19,040	$70	$1.4M

Showing 1–10 of 357

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.

Claims Volume vs. Virginia Distribution

Carilion Medical Center — 22 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

357 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	65	70	3,200	$110	$2.8M
G9012	Other specified case management service not elsewhere classified	21	120	2,160	$220	$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.	115	340	160	$130	$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.	144	630	90	$140	$1.1M
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.	158	620	70	$120	$1M
J0585	Injection, onabotulinumtoxina, 1 unit	5	20	750	$540	$871.7K
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.	20	180	2,950	$140	$783.2K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	22	170	3,390	$100	$658.8K
H0004	Behavioral health counseling and therapy, per 15 minutes	67	100	3,280	$40	$455.8K
78815	PET and CT scans are both standard imaging tools that allow doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen.…	7	40	270	$680	$417.1K

Showing 1–10 of 357

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carilion Medical Center	VA	General Acute Care Hospital	$0	$124.7M
Carilion New River Valley Medical Center	VA	General Acute Care Hospital	$0	$32.4M
Carilion Healthcare Corporation	VA	Multi-Specialty Clinic/Center	$0	$26.1M
Carilion Franklin Memorial Hospital	VA	General Acute Care Hospital	$0	$18.4M
Carilion Medical Center	VA	Emergency Medicine Physician	$0	$18.1M
Jefferson Radiology, PC	CT	Diagnostic Radiology Physician	$0	$14M
Stonewall Jackson Memorial Hospital Company	WV	Rural Acute Care Hospital	$0	$13M
Carilion Rockbridge Community Hospital	VA	Critical Access Hospital	$0	$11.8M
Carilion Emergency Services, Inc.	VA	Urgent Care Clinic/Center	$0	$11.1M
Carilion Giles Community Hospital	VA	Critical Access Hospital	$0	$10.3M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carilion Clinic Patient Transportation, LLC	VA	Air Ambulance	$2.6M	$6.1M
Quest Diagnostics Clinical Laboratories Inc	VA	Clinical Medical Laboratory	$3.9M	$186.2K
Mark Kochenderfer	VA	Hematology & Oncology Physician	$2.5M	$0
Amanda Gillespie-twardy	VA	Hematology & Oncology Physician	$1.9M	$0
Suzan Merten	VA	Hematology & Oncology Physician	$1.8M	$90
Padmaja Mallidi	VA	Hematology & Oncology Physician	$1.7M	$0
Fairlawn Surgery Center, LLC	VA	Ambulatory Surgical Clinic/Center	$997K	$572.4K
Donald Vile	VA	Hematology & Oncology Physician	$1.4M	$0
Joshua Morales	VA	Hematology & Oncology Physician	$886.1K	$0
Matthew Skelton	VA	Hematology & Oncology Physician	$821.2K	$90

Carilion Medical Center — 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