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

Why is the Medicaid comparison limited to Connecticut 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. Connecticut (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.

Prospect Rockville Hospital, Inc. (NPI 1205283538)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prospect Rockville Hospital, Inc.
Address	31 Union St
City	Vernon
State	CT
ZIP	06066
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 17, 2016

Payer Source	Total Paid
Medicaid	$30M
Medicare	$0

PROSPECT ROCKVILLE HOSPITAL, INC. reports no Medicare billing on file and $30M in lifetime Medicaid revenue, making its observable public-payer footprint effectively Medicaid-only in these datasets. The absence of Medicare claims means analyses should treat this entity as a single-payer (Medicaid) hospital when assessing payer exposure and contracting leverage.

The provider's NPI was enumerated on 2016-05-17 (~10 years ago), indicating about a decade of recorded activity under this identifier; that tenure provides several years of Medicaid claim history to evaluate trends and service-line stability.

Revenue concentration is high: the precomputed top three Medicaid codes (G0384, 99285, G0383) account for 42.8% of this provider's total Medicaid revenue. In particular, G0384 generates $6.3M (23.1% of Medicaid revenue), 99285 generates $3.3M (12.1%), and G0383 generates $2.1M (7.5%), so emergency-department services drive a large share of the hospital's Medicaid receipts.

The code mix is strongly emergency-department centric: high-volume ED encounter codes (G0384 10.4K claims, 99285 9.7K claims, G0383 9.2K claims, 99284 8K claims, G0382 10.7K claims) dominate the top-of-book revenue lines, and frequent use of infusion/administration codes (96374, 96375, 96365, 96361) and urgent imaging (74177, 70450, 71046) supports a model oriented around acute, episodic care and ED throughput rather than elective inpatient procedures. This mix suggests operational focus on emergency and short-stay services with ancillary imaging and infusion services tightly coupled to ED volume.

Competitive standing across Medicaid shows moderate market presence rather than state dominance: G0384 ranks #2 of 5 providers in-state (75th percentile; typical, unremarkable volume for this code) while 99285 ranks #44 of 129 providers (66th percentile; typical, unremarkable volume). Several other high-volume codes sit in mid-to-upper percentiles (for example, G0383 is #3 of 7, 67th percentile; 99284 is #50 of 127, 61th percentile), indicating the hospital is a meaningful but not dominant provider of ED services statewide.

There are notable ancillary service footprints beyond the ED: 97110 (therapeutic exercise) appears with 23.2K claims and $697.1K revenue, ranking #35 of 348 providers in-state (90th percentile; typical, unremarkable volume for this code), and 97140 (manual therapy) shows 14.8K claims and $563.2K revenue, ranking #28 of 120 (77th percentile). These placements indicate a visible physical therapy outpatient activity attached to the hospital's service mix, even though these lines individually represent smaller shares of total Medicaid revenue.

Operationally relevant diagnostic/testing volumes are present but not outlier-level: 87635 (SARS–CoV–2 testing) had 10.6K claims and $412.9K revenue, ranking #16 of 140 providers (89th percentile; typical, unremarkable volume), and imaging codes such as 74177 and 70450 each contribute roughly $1M and $475K respectively, with mid-range in-state ranks. These figures align with an ED-focused hospital that also handles substantial diagnostic throughput.

The hospital's Medicaid revenue profile is concentrated in a narrow set of ED codes (G0384 alone is $6.3M, 23.1% of Medicaid revenue), which creates commercial and utilization dependencies that payers and network managers should note during negotiations or network-design discussions. Given the lack of Medicare activity, any changes in Medicaid policy or payment methodology for high-impact ED codes could materially affect the provider's revenue mix.

Medicaid: Complete Services Breakdown

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

228 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0384	Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is…	10,370	$610	$6.3M
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.	9,730	$340	$3.3M
G0383	Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is…	9,200	$230	$2.1M
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.	7,980	$240	$1.9M
G0382	Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is…	10,680	$180	$1.9M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	11,750	$150	$1.8M
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.	9,390	$180	$1.7M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	12,270	$100	$1.2M
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.	4,330	$240	$1M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	23,240	$30	$697.1K

Showing 1–10 of 228

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Prospect Rockville Hospital, Inc. — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

228 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	23	40	21,520	$90	$8M
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.	44	130	520	$330	$5.9M
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.	50	130	690	$180	$4.7M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	25	40	23,540	$140	$3.7M
G0384	Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is…	2	10	3,740	$540	$3.6M
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.	47	110	1,520	$140	$3.4M
G0382	Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is…	3	10	9,120	$160	$1.5M
G0383	Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is…	3	10	4,600	$210	$1.3M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	24	30	17,770	$50	$1.1M
96360	The provider introduces a catheter intravenously for supplementation of fluid and electrolytes for 31 minutes to one hour to treat severe cases of dehydration.	24	30	7,070	$130	$1.1M

Showing 1–10 of 228

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prospect Manchester Hospital, Inc.	CT	General Acute Care Hospital	$0	$69.2M
Martin Cooper	CT	Geriatric Psychiatry Physician	$283.7K	$0
Osman Qureshi	CT	Psychiatry Physician	$244.8K	$0
Mukti Patel-prineas	CT	Family Medicine Physician	$144K	$0
Penelope Carmichael	CT	Psychiatry Physician	$28.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Vcare Family Practice, LLC	CT	Multi-Specialty Clinic/Center	$0	$4.2M
Babar Khan	CT	General Practice Dentistry	$0	$3.8M
4 Your Peace Of Mind, LLC	CT	Home Health Agency	$0	$3.8M
Vernon Public Schools	CT	Local Education Agency (LEA)	$0	$3.5M
Hockanum Valley Community Council, Inc.	CT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$3.1M
Strong Foundations	CT	Behavior Analyst	$0	$2.5M
Town Of Vernon	CT	Land Ambulance	$339.8K	$1.8M
Prospect Echn Home Health, Inc.	CT	Home Health Agency	$0	$1.7M
Ctuc01	CT	Urgent Care Clinic/Center	$0	$1.7M
Myeyedr Optometry Of Connecticut, LLC	CT	Optometrist	$0	$1.3M

Prospect Rockville Hospital, Inc. — Billing Profile & Reimbursement Data

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Prospect Rockville Hospital, 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