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.

Midstate Medical Center (NPI 1427007848)

Key Findings

Field	Value
Entity Type	Organization
Organization	Midstate Medical Center
Address	435 Lewis Avenue
City	Meriden
State	CT
ZIP	06451
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 10, 2006

Payer Source	Total Paid
Medicaid	$110.8M
Medicare	$0

MIDSTATE MEDICAL CENTER reports no Medicare billing on file and $110.8M in lifetime Medicaid revenue, making Medicaid the effective primary payer for billed services. The provider’s NPI was enumerated on 2006-05-10 (~20 years ago), so this Medicaid-dominant profile reflects a long-established facility rather than a new entrant to the market.

Revenue is highly concentrated in emergency department evaluation-and-management codes: the precomputed top-three codes (99285, 99284, 99283) account for 56.9% of the provider’s total Medicaid revenue. Those three codes individually generate $26.8M (28.3%), $17.1M (18.1%), and $10M (10.5%) respectively, indicating ED encounters are the single largest revenue driver on Medicaid.

The code mix points to a high-acuity, ED- and outpatient-focused operation. Large counts for 99285 (51.8K claims), 99284 (59.5K claims) and 99283 (48.4K claims), together with 97.1K claims for G0463, indicate substantial emergency and hospital outpatient clinic throughput and suggest staffing, bed flow, and ED capacity are central operational priorities.

Competitive standing for the ED codes is substantial but not dominant statewide: 99285 ranks #18 of 129 providers (87th percentile), 99284 ranks #20 of 127 providers (85th percentile), and 99283 ranks #23 of 114 providers (81th percentile). These percentiles indicate typical, unremarkable volumes relative to many Connecticut peers — the provider is a solid participant in ED care but not a clear statewide leader on those codes.

There are clear specialty outliers that differ from the ED concentration: 95811 (sleep study monitoring) ranks #1 of 36 providers (100th percentile) and is labeled "notably above typical state volume," signaling an unusually large sleep medicine or polysomnography program for the state sample. Similarly, 11042 (surgical debridement) ranks #3 of 66 providers (97th percentile) and is also described as "notably above typical state volume," pointing to a relative strength in wound/debridement services.

Ancillary acute-care services are well represented in the top code list: imaging codes such as 74177 ($2.5M revenue, 12.1K claims) and 70450 ($761.5K revenue, 13.1K claims) appear alongside infusion and medication administration codes like 96374 ($5.1M revenue, 34.9K claims) and 96361 ($1.8M revenue, 31.8K claims). This mix supports the conclusion that the hospital operates significant on-site imaging, infusion, and procedure capacity to support ED and inpatient care.

COVID testing appears as a recurring but non-dominant revenue stream with U0004 at $1.3M (20.3K claims, 81th percentile) and U0003 at $907.2K (11.2K claims, 71th percentile). These entries show the provider maintained testing volume during the pandemic era, but testing codes do not approach the revenue scale of ED E/M services.

Operational implications for payers and competitor analysis: very high claim volumes (e.g., G0463 97.1K claims, plus tens of thousands of ED claims for 99285/99284/99283) imply sustained patient flow that will drive negotiated rates, network access considerations, and utilization-management focus on emergency care pathways. Given the single-payer Medicaid concentration and strong ED/specialty procedure mix, analysts should prioritize review of ED utilization, outpatient clinic capacity, sleep study services, and wound care programs when benchmarking this provider against in-state peers.

Medicaid: Complete Services Breakdown

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

425 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	51,850	$520	$26.8M
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.	59,520	$290	$17.1M
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.	48,440	$210	$10M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	97,090	$100	$9.8M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	34,870	$150	$5.1M
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.	12,150	$210	$2.5M
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.	5,840	$420	$2.4M
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…	3,230	$690	$2.2M
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.	31,750	$60	$1.8M
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	12,530	$140	$1.8M

Showing 1–10 of 425

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

Midstate Medical Center — 3 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

425 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	7	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.	18	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.	20	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.	11	40	23,540	$140	$3.7M
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.	23	110	1,520	$140	$3.4M
47562	The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease.	6	10	160	$4,170	$1.1M
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.	9	30	17,770	$50	$1.1M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	16	40	1,910	$190	$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.	12	30	7,070	$130	$1.1M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	16	40	5,360	$120	$1M

Showing 1–10 of 425

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Midstate Medical Center	CT	General Acute Care Hospital	$0	$1.3M
John Granquist	CT	Cardiovascular Disease Physician	$218.7K	$0
David Altszuler	CT	Cardiovascular Disease Physician	$195.7K	$0
Kevin Tally	CT	Cardiovascular Disease Physician	$193.3K	$0
John Mccallum	CT	Orthopaedic Surgery Physician	$182.9K	$0
George Spivack	CT	Cardiovascular Disease Physician	$179.2K	$0
Maximilian Lee	CT	Cardiovascular Disease Physician	$172.3K	$0
Andrew Feingold	CT	Cardiovascular Disease Physician	$164.8K	$0
Steven Bleich	CT	Cardiovascular Disease Physician	$163.2K	$0
John Dinkler	CT	Cardiovascular Disease Physician	$163K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hunter's Ambulance Service, Inc.	CT	Ambulance	$4.2M	$25.5M
Emergency Medicine Physicians Of New Haven County,llc	CT	Emergency Medicine Physician	$0	$8.6M
Midstate Gastroenterology Specialists PC	CT	Gastroenterology Physician	$0	$6.6M
Midstate Radiology Associates, LLC	CT	Diagnostic Radiology Physician	$0	$6.6M
Nems PLLC	CT	Emergency Medicine Physician	$0	$6.1M
B.e.k Eyecare, Inc	CT	Optometrist	$0	$3.7M
Apple Dental And Associates,llc	CT	General Practice Dentistry	$0	$2.1M
Connecticut Counseling Centers, Inc	CT	Methadone Clinic	$0	$2M
Franciscan Family Care Center, Inc.	CT	Home Health Agency	$0	$1.8M
Sph Meriden LLC	CT	General Practice Dentistry	$0	$1.1M

Midstate Medical Center — Billing Profile & Reimbursement Data

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Midstate Medical Center — 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