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.

Randall J. Hill, M.d., P.L.L.C. (NPI 1821029547)

Randall J. Hill, M.d., P.L.L.C. is a specialist provider located in Charleston, West Virginia. This profile covers 0 Medicare and 26 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	Randall J. Hill, M.d., P.L.L.C.
Address	830 Pennsylvania Ave
City	Charleston
State	WV
ZIP	25302
Taxonomy	Specialist
NPI Enumerated	July 5, 2006

Payer Source	Total Paid
Medicaid	$1.9M
Medicare	$0

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

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	13,170	$60	$737.2K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	5,970	$50	$316.4K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	6,370	$30	$216.6K
93975	The provider performs a complete study of the abdominal, pelvic, scrotal, and or retroperitoneal organs using duplex ultrasound. He performs the procedure to examine the vascular supply to the organs…	940	$160	$147.3K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	1,540	$70	$99.8K
81002	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dip stick, and shakes off the excess urine. Alternatively, the analyst may place drops of the urine specimen…	10,260	$10	$92.4K
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	1,580	$50	$83.8K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	840	$80	$65.8K
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	770	$80	$57.5K
76815	The provider performs a limited examination of the fetus using ultrasound. The provider performs the examination of certain parameters for one or more fetuses.	440	$50	$19.6K

Showing 1–10 of 26

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

Randall J. Hill, M.d., P.L.L.C. — 2 of 24 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

26 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	177	1,270	1,240	$30	$245K
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…	131	190	660	$40	$226.4K
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…	921	1,030	890	$50	$221K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	21	50	730	$60	$126.6K
93975	The provider performs a complete study of the abdominal, pelvic, scrotal, and or retroperitoneal organs using duplex ultrasound. He performs the procedure to examine the vascular supply to the organs…	4	20	130	$120	$76.7K
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	28	80	390	$60	$69.4K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	2	20	740	$30	$69.3K
59430	For this service, the provider or nonphysician healthcare professional provides care to the patient in the outpatient setting following the delivery. Routine postpartum care can involve one or more…	18	30	90	$170	$64.7K
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…	157	190	110	$70	$63.4K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	1	30	310	$50	$62.3K

Showing 1–10 of 26

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Virginia University Medical Corporation	WV	Family Medicine Physician	$0	$162.1M
Florida Hospital Medical Group Inc	FL	Family Medicine Physician	$0	$71.2M
City Hospital, Inc	WV	General Acute Care Hospital	$0	$41.1M
Adventist Health System-sunbelt, Inc	FL	Clinical Medical Laboratory	$0	$28.2M
Florida Hospital Physician Group Inc	FL	Family Medicine Physician	$0	$21.4M
Memorial Hospital Flagler Inc	FL	General Acute Care Hospital	$0	$13.9M
Florida Hospital Medical Group Inc	FL	Diagnostic Radiology Physician	$0	$13.1M
Sedigheh Ebadi	FL	Pediatrics Physician	$0	$10.1M
Memorial Health Systems Inc	FL	Surgery Physician	$0	$7.4M
Daniel Novick	NY	Vascular & Interventional Radiology Physician	$3M	$658.6K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Healthnet Aeromedical Services Inc.	WV	Air Ambulance	$4.1M	$24.1M
Home Base Inc.	WV	Community/Behavioral Health Agency	$0	$14.5M
Appalachian Labs Of Wv LLC	WV	Clinical Medical Laboratory	$359.3K	$11M
Womencare Inc	WV	Federally Qualified Health Center (FQHC)	$0	$7.4M
Allied Nursing And Community Service	WV	Case Management Agency	$0	$5.4M
Devaraj Behavioral Healthcare PLLC	WV	Community/Behavioral Health Agency	$0	$4.8M
Pediatrix Medical Group PC	WV	Neonatal-Perinatal Medicine Physician	$0	$3.7M
South Charleston Pediatrics	WV	Pediatrics Physician	$0	$3.6M
Abc Pediatrics, PLLC	WV	Pediatrics Physician	$0	$2.9M
Kanawha Valley Senior Services	WV	Home Health Agency	$0	$2.2M

Randall J. Hill, M.d., P.L.L.C. — 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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