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 Waterbury, Inc. (NPI 1477902641)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prospect Waterbury, Inc.
Address	64 Robbins St
City	Waterbury
State	CT
ZIP	06708
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 8, 2016

Payer Source	Total Paid
Medicaid	$84.6M
Medicare	$0

This provider is effectively single-payer in the available claims data: there is no Medicare billing on file and all reported federal revenue is from Medicaid, totaling $84.6M. That payer mix indicates the hospital’s financial footprint in the federal programs is concentrated on Medicaid-covered care rather than Medicare-covered populations. The NPI was enumerated 2016-06-08 (~10 years ago), confirming it has been an active billing entity for about a decade.

Revenue concentration is heavily weighted toward emergency department E/M services: the top three Medicaid codes account for 61.8% of this provider’s total Medicaid revenue, driven by 99285 ($20.1M), 99284 ($14.2M), and 99283 ($9.8M). These three high-volume E/M codes dominate the revenue mix, signaling that acute ED visits are the principal revenue drivers within Medicaid billing.

Operationally, the code mix and volumes point to a high-throughput emergency department: 99285 has 38.2K claims, 99284 has 46.9K claims, and 99283 has 47.8K claims, with average paid/claim levels of $525, $302, and $206 respectively. The combination of large claim counts and material average payments for E/M codes suggests substantial ED utilization and frequent management of moderate-to-severe acute presentations.

Beyond ED visits, the provider shows a significant outpatient diagnostic and procedural footprint. Notable items include 78452 ($2.6M, ranks #3 of 56, 96th percentile—labeled notably above typical state volume), 74177 ($2M, 66th percentile), 70450 ($1.2M, 75th percentile), and 93306 ($1.9M, 80th percentile), indicating regular use of nuclear cardiology, CT imaging, head CT, and transthoracic echocardiography in its service mix.

Therapeutic and infusion services are also a material part of the billing mix: 96374 ($3.9M, 27.1K claims), 96360 ($1.3M, 9.6K claims), 96365 ($977.5K, 7.5K claims), 96375 ($702.1K, 16K claims), and 96361 ($693.1K, 17.8K claims) appear throughout the top codes. These codes reflect frequent IV medication administration and fluid resuscitation consistent with ED and short-stay acute care workflows rather than primarily ambulatory clinic infusion programs.

Behavioral health and substance-use treatment appear as established service lines in the outpatient mix: H0015 ($1M, 8.3K claims, 70th percentile) and S9480 ($960.3K, 7.7K claims, 61st percentile) indicate the provider offers intensive outpatient substance use and psychiatric programs at typical in-state volumes. Complementing that, broad use of point-of-care drug testing (80307: 34.5K claims, $689.6K, 89th percentile) underscores routine behavioral-health and ED screening activity.

Competitive standing is mixed across service lines: for its ED E/M codes the provider ranks in the upper-middle of in-state peers (99285 at the 81st percentile, 99284 at the 79th percentile, and 99283 at the 79th percentile) which the source labels as typical/unremarkable volumes, so it is a solid but not dominant statewide ED player. In contrast, it is a clear outlier for certain diagnostics—78452 ranks #3 of 56 (96th percentile, notably above typical) and 87635 ranks #5 of 140 (97th percentile, notably above typical)—indicating pockets of above-typical activity in nuclear cardiology and SARS–COV–2 testing.

A small number of high-priced, low-volume procedures and surgeries contribute meaningfully on a per-claim basis but are not dominant overall: for example, 58661 generated $890.9K on 176 claims with an average paid/claim of $5062 (rank #3 of 5, 50th percentile), showing occasional higher-acuity gynecologic surgery activity. These high-average-payment codes supplement an otherwise ED- and diagnostics-driven Medicaid revenue base rather than defining it.

Medicaid: Complete Services Breakdown

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

435 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.	38,240	$530	$20.1M
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.	46,920	$300	$14.2M
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.	47,800	$210	$9.8M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	27,110	$150	$3.9M
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	4,760	$540	$2.6M
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.	9,810	$210	$2M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	7,750	$240	$1.9M
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.	9,630	$140	$1.3M
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.	13,370	$90	$1.2M
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	1,600	$720	$1.2M

Showing 1–10 of 435

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 Waterbury, Inc. — 2 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

435 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	22	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.	25	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.	27	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.	16	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.	25	110	1,520	$140	$3.4M
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…	23	70	3,710	$120	$1.6M
S9480	Intensive outpatient psychiatric services, per diem	23	60	5,640	$110	$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.	17	30	17,770	$50	$1.1M
J2357	Injection, omalizumab, 5 mg	5	10	470	$830	$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…	39	40	1,910	$190	$1.1M

Showing 1–10 of 435

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Access Rehab Centers, LLC	CT	Rehabilitation Clinic/Center	$0	$36.9M
Emergency Physicians Of Connecticut PC	CT	Emergency Medicine Physician	$0	$10.8M
Connecticut Counseling Centers Inc	CT	Methadone Clinic	$196.2K	$9.9M
Pediatric Assoc Of Conn PC	CT	Pediatrics Physician	$0	$8.5M
Refocus Eye Health Of Central Connecticut, P.C.	CT	Ophthalmology Physician	$0	$8.2M
Myeyedr Optometry Of Connecticut, LLC	CT	Optometrist	$0	$4.7M
General Hearing	CT	Hearing Instrument Specialist	$0	$4.3M
Connecticut Neurodevelopmental Services	CT	Neurology with Special Qualifications in Child Neurology Physician	$0	$4M
Easter Seal Rehabilitation Center	CT	Rehabilitation Clinic/Center	$0	$3.9M
Bidarkote Somanath	CT	Pediatrics Physician	$0	$3.6M

Prospect Waterbury, 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

Nearby Providers

Frequently Asked Questions

References