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

Why is the Medicaid comparison limited to Puerto Rico 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. Puerto Rico (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.

Metrohealth, Inc. (NPI 1275580763)

Metrohealth, Inc. is a general acute care hospital provider located in San Juan, Puerto Rico. This profile covers 0 Medicare and 28 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	Metrohealth, Inc.
Address	1785 Carr 21
City	San Juan
State	PR
ZIP	00921
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 28, 2006

Payer Source	Total Paid
Medicaid	$905.1K
Medicare	$0

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	1,580	$160	$258.5K
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.	2,300	$80	$186.5K
74178	The provider performs computed tomography of the abdomen and pelvis without contrast material in one or both body regions followed by contrast material in one or both body regions and additional…	680	$160	$106K
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.	690	$150	$102.8K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	5,410	$10	$48.7K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	7,340	$10	$44.1K
76641	In this procedure, the provider performs a complete ultrasound of one breast. The procedure includes documentation of the images.	2,020	$20	$42.3K
76700	An abdominal ultrasound is a noninvasive procedure used to assess the body parts within the abdomen (i.e. liver, gallbladder, pancreas, bile ducts, spleen, and abdominal aorta). This particular code…	1,180	$30	$31.8K
77066	The provider performs X–ray imaging on both breasts in a patient with a lump or suspected cancer and may use specially designed computer software to help identify or diagnose potential abnormalities…	1,680	$20	$26.8K
77067	The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software…	620	$20	$14.3K

Showing 1–10 of 28

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Puerto Rico Distribution

Metrohealth, Inc. — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Puerto Rico

Full comparison — all codes billed, vs. Puerto Rico median

28 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	32	80	900	$110	$242K
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.	36	70	730	$110	$178.7K
77067	The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software…	95	150	1,180	$70	$170.3K
76641	In this procedure, the provider performs a complete ultrasound of one breast. The procedure includes documentation of the images.	61	180	890	$70	$145.5K
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.	32	80	1,150	$50	$125.5K
77066	The provider performs X–ray imaging on both breasts in a patient with a lump or suspected cancer and may use specially designed computer software to help identify or diagnose potential abnormalities…	31	130	480	$90	$109.4K
76700	An abdominal ultrasound is a noninvasive procedure used to assess the body parts within the abdomen (i.e. liver, gallbladder, pancreas, bile ducts, spleen, and abdominal aorta). This particular code…	70	230	510	$60	$61K
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.	79	220	290	$60	$47.2K
76536	The provider performs real–time ultrasound examination of the soft tissues of the head and neck and records and saves the images for later review.	138	170	310	$60	$46.5K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	38	260	850	$10	$27.8K

Showing 1–10 of 28

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jeffrey Zuckerman	PR	Diagnostic Radiology Physician	$131.1K	$2.1K
Fernando Lopez Rodriguez	PR	Neuroradiology Physician	$41.6K	$37.6K
Armando Bonnet-mercier	PR	Diagnostic Radiology Physician	$62.5K	$0
Josue Vazquez Delgado	PR	Diagnostic Radiology Physician	$26.4K	$0
Rafael Vaquer	PR	Diagnostic Radiology Physician	$25.3K	$0
Irma Colon	PR	Diagnostic Radiology Physician	$17.1K	$0
Carmen Alvarez-villar	PR	Diagnostic Radiology Physician	$15.4K	$0
Uriel Camacho	PR	Diagnostic Radiology Physician	$14.1K	$0
Angela Mendez De Guzman	PR	Diagnostic Radiology Physician	$10.6K	$0
Francisco Gomez Goytia	PR	Diagnostic Radiology Physician	$8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jose Garcia Gonzalez	PR	Retina Specialist (Ophthalmology) Physician	$1.9M	$3.4M
Recinto De Ciencias Medicas	PR	Obstetrics & Gynecology Physician	$0	$3.8M
Medical Pharmacy And Lab	PR	Exclusive Provider Organization	$0	$2.5M
Metrohealth Radiation Oncology Group, Inc.	PR	Specialist	$0	$2.5M
Metropolitan Mri Associates Psc	PR	Neuroradiology Physician	$0	$2.1M
Pediatrics Management Services	PR	Medical Specialty Clinic/Center	$0	$1.8M
Luis Rodriguez	PR	Diagnostic Radiology Physician	$2K	$1.3M
Minerva Nunez	PR	General Practice Dentistry	$0	$761.4K
Elizabeth Calderon-alicea	PR	Hematology & Oncology Physician	$0	$707.2K
Las Lomas Laboratory Inc.	PR	Clinical Medical Laboratory	$29.6K	$630.1K

Metrohealth, Inc. — Billing Profile & Reimbursement Data

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Metrohealth, 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

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