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 Manchester Hospital, Inc. (NPI 1316394638)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prospect Manchester Hospital, Inc.
Address	71 Haynes St
City	Manchester
State	CT
ZIP	06040
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 17, 2016

Payer Source	Total Paid
Medicaid	$69.2M
Medicare	$0

PROSPECT MANCHESTER HOSPITAL, INC. is effectively a single-payer Medicaid hospital in the available data: there is no Medicare billing on file and all reported lifetime federal payer revenue is Medicaid totaling $69.2M. This profile should be treated as Medicaid-dominant for payer-mix analyses and benchmarking.

Revenue concentration is high: the precomputed top three Medicaid codes account for 38.8% of the provider's total Medicaid revenue. Those top drivers are G0384 ($10.2M revenue, 17.7K claims, $575 avg paid/claim, 18.9% of total Medicaid revenue), 99285 ($6.7M revenue, 19.6K claims, $340 avg paid/claim, 12.4% of total Medicaid revenue), and 99284 ($4M revenue, 17.6K claims, $228 avg paid/claim, 7.5% of total Medicaid revenue).

The code mix and volumes indicate this hospital operates with a major emergency department footprint and a strong observation/acute-care throughput. High-volume ED codes (G0384, 99285, 99284, G0383, G0382) and observation admissions (G0379, $1.4M revenue, 2.8K claims, $522 avg paid/claim) point to ED-driven inpatient and short-stay utilization rather than outpatient clinic-dominant care.

The provider is a leading in-state performer on several hospital-level ED and observation codes: G0384 ranks #1 of 5 providers in-state at the 100th percentile and is described as notably above typical state volume, G0383 ranks #1 of 7 (100th percentile; notably above typical state volume), and G0379 ranks #1 of 8 (100th percentile; notably above typical state volume). By contrast, 99285 is ranked #35 of 129 providers in-state (73th percentile) and 99284 is #42 of 127 (67th percentile), indicating dominant standing on some hospital-specific revenue lines but more typical volumes on physician E/M ED codes.

Beyond emergency care, the hospital shows a broad acute-service portfolio: procedural and imaging codes such as 45380 ($2.1M), 43239 ($1.9M), 74177 ($1.9M), and 70450 ($929.5K) appear in the top Medicaid revenue list, reflecting endoscopy, CT, and other diagnostic capabilities that support inpatient and same-day surgical activity. These ancillary high-revenue items confirm the facility provides a full acute-care spectrum rather than a narrowly focused ambulatory center.

Behavioral health, physical therapy, and infusion services contribute meaningful Medicaid revenue and diversify the clinical footprint: S9480 (intensive outpatient psychiatric services) generates $1.4M, psychotherapy 90834 generates $988.6K, and high-count therapy codes like 97110 (34.8K claims, $36 avg paid/claim, $1.3M) and 97140 (19K claims, $36 avg paid/claim, $683.9K) indicate sizable rehab and mental-health outpatient volume. Coupled with infusion/IV administration codes (96374, 96365, 96375), this mix suggests hospital-based ambulatory treatment lines in addition to emergency and inpatient care.

Operationally, the hospital’s Medicaid volume profile is high-frequency, lower-per-claim on many lines: for example, G0384 shows $575 avg paid/claim while physician-level ED code 99285 shows $340 avg paid/claim and 99284 shows $228 avg paid/claim. This pattern is consistent with a facility relying on large ED throughput and hospital-billed encounter codes to generate the bulk of Medicaid revenue.

The provider has an established enrollment history with NPI enumeration on 2016-05-17 (~10 years ago), indicating roughly a decade of being active under its current NPI for trend and longitudinal analyses. Use multi-year Medicaid utilization trends to assess whether the current ED- and observation-heavy mix is stable, growing, or a recent shift given the concentrated reliance on a few top codes.

Medicaid: Complete Services Breakdown

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

410 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…	17,690	$580	$10.2M
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.	19,600	$340	$6.7M
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.	17,620	$230	$4M
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…	16,690	$230	$3.8M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	23,540	$140	$3.4M
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.	18,920	$170	$3.2M
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…	16,820	$170	$2.8M
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	2,950	$710	$2.1M
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.	8,430	$230	$1.9M
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.	4,430	$430	$1.9M

Showing 1–10 of 410

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 Manchester Hospital, Inc. — 4 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

410 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	26	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.	35	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.	42	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.	19	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…	1	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.	39	110	1,520	$140	$3.4M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	6	10	2,820	$160	$1.6M
J3380	Injection, vedolizumab, intravenous, 1 mg	6	10	220	$3,930	$1.6M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	46	70	3,710	$120	$1.6M
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…	2	10	9,120	$160	$1.5M

Showing 1–10 of 410

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prospect Rockville Hospital, Inc.	CT	General Acute Care Hospital	$0	$30M
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
Prospect Ct Medical Foundation, Inc.	CT	Family Medicine Physician	$0	$34M
Columbia Oral Maxillofacial Imaging LLC	CT	Dentist	$0	$19.4M
Eastern Connecticut Cardiology Associates LLC	CT	Cardiovascular Disease Physician	$0	$8.5M
Abuelos Care Inc.	CT	Home Health Agency	$0	$7M
Eastern Connecticut Pathology Consultants, PC	CT	Anatomic Pathology & Clinical Pathology Physician	$0	$4M
Emergency Care Services Of Connecticut, P.C.	CT	Emergency Medicine Physician	$0	$3.4M
Abc Pediatrics LLC	CT	Pediatrics Physician	$0	$1.7M
Advanced Psychological Services, LLC	CT	Clinical Psychologist	$0	$1.7M
Dr. Dental Of Manchester, PC	CT	Dentist	$0	$1.4M
Anjum Khera	CT	Specialist	$0	$1.3M

Prospect Manchester 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