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

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

Bayhealth Medical Center, Inc. (NPI 1467546135)

Field	Value
Entity Type	Organization
Organization	Bayhealth Medical Center, Inc.
Address	640 South State Street
City	Dover
State	DE
ZIP	19901
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 3, 2006

Payer Source	Total Paid
Medicaid	$79.3M
Medicare	$0

Key Findings

This provider is effectively single‑payer on file: BAYHEALTH MEDICAL CENTER, INC. reports no Medicare billing on file and $79.3M in lifetime Medicaid revenue, indicating the organization’s reported outpatient/inpatient activity in the dataset is concentrated in Medicaid rather than Medicare. The absence of Medicare claims on file makes Medicaid the primary lens for assessing service mix and competitive position for this entity.

Revenue concentration is high among a small set of emergency/ED visit codes: the top 3 Medicaid codes (99283, 99281, 99282) together account for 35.7% of the provider’s total Medicaid revenue. Individually those codes include 99283 (53.9K claims, $169 avg paid/claim, $9.1M revenue; 16.6% of Medicaid revenue), 99281 (32.6K claims, $161 avg paid/claim, $5.2M revenue; 9.6%), and 99282 (29.4K claims, $176 avg paid/claim, $5.2M revenue; 9.4%), which shows a heavy dependence on ED evaluation-and-management services for revenue.

The code mix and volumes indicate BAYHEALTH operates a high-volume emergency department with substantial observation throughput: multiple ED E/M codes (99281–99285) appear among top revenue drivers and hospital observation G0378 (22.9K claims, $198 avg paid/claim, $4.5M revenue; ranks #1 of 7, 100th percentile) is a material line item. High paid/claim levels on moderate-to-complex ED codes like 99284 and 99285 alongside strong observation hours suggest a clinical workflow that frequently escalates from ED assessment to monitored observation care.

Laboratory and basic diagnostic throughput is unusually large: 80053 (CMP) shows 89.2K claims for $1.1M revenue and ranks #1 of 13 (100th percentile), 85025 (CBC) is 116.6K claims for $1.7M revenue and ranks #2 of 34 (97th percentile), and 36415 (venipuncture) is 148.9K claims for $744.6K revenue and ranks #1 of 35 where it is labeled an "extreme outlier, far above typical state volume." Together these observations point to very high specimen collection and lab-processing volumes consistent with a busy hospital emergency/outpatient footprint.

Imaging and advanced diagnostics are also prominent components of the outpatient mix: 74177 CT abdomen/pelvis (8.8K claims, $334 avg paid/claim, $2.9M revenue), 70450 CT head (12K claims, $124 avg paid/claim, $1.5M revenue), 71275 CTA chest (2.8K claims, $287 avg paid/claim, $794.1K revenue), and cardiac imaging 93306 (1.8K claims, $623 avg paid/claim, $1.1M revenue) all appear among top Medicaid codes. These volumes and revenues indicate in‑house cross-sectional and cardiac imaging capability that supports ED and inpatient diagnostic workflows.

Infusion and medication administration in the outpatient/ED setting are meaningful contributors: 96375 (18.8K claims, $62 avg paid/claim, $1.2M revenue; ranks #1 of 10, 100th percentile), 96374 (27.1K claims, $41 avg paid/claim, $1.1M revenue; ranks #1 of 9, 100th percentile with "typical, unremarkable volume"), 96365 (8.1K claims, $97 avg paid/claim, $787.6K revenue; ranks #1 of 8, 100th percentile) and 96361 (11.7K claims, $65 avg paid/claim, $757.8K revenue) show frequent use of IV/infusion therapies consistent with ED treatments and short‑stay infusion services. This pattern reinforces an operational emphasis on acute care interventions delivered in the ED/observation setting.

State competitive standing is strong in several service lines: the provider ranks at or near the top of the state for G0378 (100th percentile, #1 of 7), 80053 (100th, #1 of 13), 96375 (100th, #1 of 10), 96365 (100th, #1 of 8), 87633 (100th, #1 of 8, "notably above typical"), and 36415 (100th, #1 of 35, "extreme outlier"). At the same time, the core ED E/M codes have high but not dominant statewide ranks (e.g., 99283 at the 84th percentile and #5 of 26, 99282 at the 87th percentile and #3 of 16, 99281 at the 89th percentile and #2 of 10), which frames the hospital as a major in‑state provider for lab, imaging, infusion, and observation services and a high‑volume but not uniformly dominant ED operator.

The provider has an established operational tenure with NPI enumeration dated 2006-10-03 (~20 years ago), which, combined with $79.3M in Medicaid revenue and the described high volumes across ED, observation, lab, imaging, and infusion codes, supports classification as an established, large community acute care hospital largely reliant on Medicaid‑payer activity in this dataset.

Medicaid: Complete Services Breakdown

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

407 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.	53,930	$170	$9.1M
99281	The provider sees a patient for the lowest level emergency department visit.	32,580	$160	$5.2M
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.	29,370	$180	$5.2M
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.	26,360	$190	$4.9M
G0378	Hospital observation service, per hour	22,850	$200	$4.5M
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.	8,770	$330	$2.9M
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.	17,130	$150	$2.5M
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	40,410	$40	$1.8M
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	116,590	$20	$1.7M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	27,570	$60	$1.7M

Showing 1–10 of 407

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

Bayhealth Medical Center, Inc. — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

407 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	5	30	11,180	$110	$3.4M
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.	9	40	770	$110	$1.9M
G0378	Hospital observation service, per hour	1	10	6,600	$190	$1.5M
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.	7	30	1,350	$110	$1.5M
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.	3	20	4,570	$120	$1.4M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	6	10	350	$2,060	$1.2M
99281	The provider sees a patient for the lowest level emergency department visit.	2	10	110	$130	$1M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	4	10	1,340	$530	$829.8K
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	10	4,520	$120	$820.3K
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	2	10	19,210	$30	$794.8K

Showing 1–10 of 407

Related Providers

Other providers that share a Tax Identification Number (TIN) with Bayhealth Medical Center, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bayhealth Medical Center, Inc.	DE	General Acute Care Hospital	$0	$39.5M
Christiana Care Health Services Inc	DE	Hospitalist Physician	$0	$13.6M
Bayhealth Medical Center, Inc	DE	Colon & Rectal Surgery Physician	$0	$12.4M
Bayhealth Medical Center, Inc.	DE	Clinic/Center	$0	$3.7M
Tyler Yerkes	DE	Physician Assistant	$1.1M	$0
Eranga Haththotuwa	DE	Cardiovascular Disease Physician	$694.5K	$0
Sankalp Pathak	NJ	Interventional Cardiology Physician	$639.9K	$0
Pranitha Naini	VA	Medical Oncology Physician	$595.3K	$0
Megdad Zaatreh	NJ	Neurology Physician	$582.2K	$3.8K
Bayhealth Medical Center, Inc	DE	Anatomic Pathology Physician	$0	$502.9K

Nearby Providers

Other providers in the same ZIP code as Bayhealth Medical Center, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bayhealth Emergency Physicians LLC	DE	Emergency Medicine Physician	$0	$16.7M
Ahl And O'connor Orthodontics, LLC	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$12.5M
State Of Delaware	DE	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$8.2M
The Children's Secret Garden	DE	Medically Fragile Infants and Children Day Care	$0	$8.1M
Apogee Medical Group, Delaware, Inc	DE	Internal Medicine Physician	$0	$7.9M
First State Oral And Maxillofacial Surgery Corp	DE	Oral and Maxillofacial Surgery (Dentist)	$0	$5M
Jamie Ahl	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$4.9M
Kent Diagnostic Radiology Associates PA	DE	Diagnostic Radiology Physician	$0	$4.6M
The Mind And Body Consortium, LLC.	DE	Psychiatry Physician	$0	$3.9M
State Of Delaware	DE	State or Local Public Health Clinic/Center	$0	$3.8M

Bayhealth Medical Center, 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