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

Why is the Medicaid comparison limited to New Jersey 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. New Jersey (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.

Capital Health System, Inc. (NPI 1073516183)

Field	Value
Entity Type	Organization
Organization	Capital Health System, Inc.
Address	1 Capital Way
City	Pennington
State	NJ
ZIP	08534
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 23, 2005

Payer Source	Total Paid
Medicaid	$132.1M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-focused hospital: there is no Medicare billing on file and total reported Medicaid revenue is $132.1M, indicating that Medicaid is the dominant (and for these data, essentially the only) public payer contributing to this facility’s billed revenue. Analysts should therefore treat this profile as single-payer (Medicaid) when evaluating payer mix and capacity planning.

Revenue is highly concentrated in a small set of codes: the precomputed top three Medicaid codes account for 55.1% of the provider’s total Medicaid revenue, driven by 99283 ($29.1M, 26.2% of Medicaid revenue), 99284 ($19.5M, 17.5%), and G0378 ($12.7M, 11.4%). This concentration signals that emergency department evaluation-and-management and hospital observation services are the principal revenue drivers for the facility.

Operational profile: the top codes by volume and revenue point to very high emergency-department throughput plus short-stay observation care. The facility reported 71.1K claims for 99283 and 51.9K claims for 99284, and 11.4K claims for G0378 (hospital observation service); together these codes reflect a mix of low-to-moderate acuity ED visits and hour-based observation services consistent with a high-volume acute-care ED managing many short stays.

Competitive standing within the state is mixed by code: for lower-acuity ED visits 99283 the provider ranks #18 of 262 providers in-state (93th percentile; notably above typical state volume for this code), indicating it is a major regional provider of that service. By contrast 99284 ranks #31 of 319 providers in-state (91th percentile; typical, unremarkable volume for this code) and G0378 ranks #21 of 78 providers in-state (74th percentile; typical, unremarkable volume for this code), implying strong absolute volume for some ED services but not uniform dominance across all observation/ED categories.

Maternity and fetal-monitoring services are a meaningful secondary revenue stream: 59025 generated $6.3M (5.7% of Medicaid revenue) with 8.2K claims and ranks #8 of 96 providers in-state (93th percentile; notably above typical state volume for this code). This, together with multiple obstetric ultrasound codes (76811, 76816, 76801 appearing in the top-25), indicates a substantial maternity care footprint supporting both delivery and prenatal monitoring.

Diagnostic imaging and cardiology procedure mix demonstrates breadth beyond ED care but at lower share: 93306 (echocardiography) produced $4.5M (4.0%) and ranks #39 of 325 providers in-state (88th percentile; typical, unremarkable volume for this code), while CT, MRI, PET, and other imaging codes (74177, 70553, 78815, 70450) appear in the top-25 with typical state percentile placements. These entries show the hospital provides a full suite of diagnostic imaging services but they do not concentrate revenue to the same degree as ED/observation codes.

There are notable outpatient procedure concentrations beyond ED imaging: OP379 has 12.4K claims and $682.9K revenue and ranks #2 of 21 providers in-state (95th percentile; notably above typical state volume for this code), suggesting a specific outpatient procedure area where this provider is a state-level outlier. OP250 also shows very high claim volume (39.5K claims) but is characterized as typical in state percentile (74th percentile), indicating some high-claim administrative or bundled outpatient activity that merits follow-up coding-level review.

Service-line diversity is moderate: the presence of 96413 (chemotherapy) generating $656.4K (0.6% of Medicaid revenue) and 45380 (colonoscopy) generating $1.2M (1.1%) points to availability of ambulatory oncology and GI procedural capacity, but these specialties represent modest shares of total Medicaid revenue compared with ED/observation. For payers and network planners, this mix signals a hospital that combines a high-throughput ED/observation core with supporting surgical, imaging, obstetric, and selected specialty services.

The provider has an established tenure in the dataset, with NPI enumerated on 2005-05-23 (~21 years ago), supporting interpretations of these patterns as reflective of a mature facility rather than a recent entrant; historical presence combined with concentrated Medicaid volume suggests strategic relevance for Medicaid network contracting in this market.

Medicaid: Complete Services Breakdown

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

350 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	71,060	$410	$29.1M
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.	51,880	$380	$19.5M
G0378	Hospital observation service, per hour	11,430	$1,110	$12.7M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	22,380	$330	$7.3M
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	8,230	$770	$6.3M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	1,450	$3,700	$5.4M
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.	13,720	$330	$4.5M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	5,320	$840	$4.5M
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.	1,800	$2,230	$4M
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	2,880	$790	$2.3M

Showing 1–10 of 350

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Jersey Distribution

Capital Health System, Inc. — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Jersey

Full comparison — all codes billed, vs. New Jersey median

350 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0378	Hospital observation service, per hour	21	80	6,290	$690	$6.6M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	57	130	3,180	$60	$4.2M
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.	18	260	4,240	$220	$4.1M
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.	31	320	580	$230	$4M
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.	72	280	920	$200	$2.6M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	10	30	860	$1,530	$2.1M
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.	76	150	3,680	$30	$1.5M
86480	The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies.	37	40	810	$30	$1.4M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	14	140	1,410	$180	$1.3M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	85	120	900	$20	$971.9K

Showing 1–10 of 350

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Capital Health System Inc	NJ	General Acute Care Hospital	$0	$114.5M
St. Francis Medical Center	NJ	General Acute Care Hospital	$0	$30.6M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Myrnaivette Pierson	NJ	Nurse Practitioner	$471.2K	$17.6K
Ilya Rozenbaum	NJ	Ophthalmology Physician	$425.2K	$0
Nikhil Thaker	NJ	Radiation Oncology Physician	$209.4K	$0
Thomas Drames	NJ	Critical Care Medicine (Internal Medicine) Physician	$207.1K	$0
Richard Amara	NJ	Clinical Cardiac Electrophysiology Physician	$154.6K	$0
Scott Warren	NJ	Foot Surgery Podiatrist	$154.5K	$0
Shivaprasad Marulendra	NJ	Gastroenterology Physician	$68.8K	$61.3K
Michael Orland	NJ	Emergency Medicine Physician	$117.9K	$0
Nabil Mesiha	NJ	Critical Care Medicine (Internal Medicine) Physician	$95.7K	$1.8K
Shirnett Williamson	NJ	Radiation Oncology Physician	$91.6K	$0

Capital Health System, 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