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

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

Mainehealth (NPI 1629761978)

Mainehealth is a family medicine physician provider located in Portland, Maine. This profile covers 0 Medicare and 91 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	Mainehealth
Address	110 Free St
City	Portland
State	ME
ZIP	04101
Taxonomy	Family Medicine Physician
NPI Enumerated	June 1, 2023

Payer Source	Total Paid
Medicaid	$2.7M
Medicare	$0

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

91 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	18,260	$50	$821.5K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	5,070	$70	$364.8K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	9,040	$40	$343.6K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	2,460	$80	$184.3K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	5,260	$20	$121K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	3,290	$30	$82.3K
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…	2,800	$30	$81.1K
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	1,220	$50	$58.4K
76815	The provider performs a limited examination of the fetus using ultrasound. The provider performs the examination of certain parameters for one or more fetuses.	2,550	$20	$48.5K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	450	$100	$42.8K

Showing 1–10 of 91

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Mainehealth — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

91 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2022	Case management, per month	33	40	800	$190	$780.3K
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.	30	30	200	$250	$316.8K
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…	14	40	1,830	$90	$292.9K
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,…	13	20	370	$340	$277.2K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	7	10	280	$200	$251.2K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	8	30	410	$50	$232.4K
90960	The provider manages all the services associated with the monthly care of a patient who is 20 years old or older and has a condition known as end stage renal disease or ESRD. For this service, the…	6	10	3,260	$70	$211.4K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	37	460	1,240	$30	$190K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	3	10	50	$2,270	$179K
93304	The provider performs a limited or follow–up transthoracic echocardiography to obtain images of the heart through the chest wall in patients born with heart defects. It is a limited examination of a…	5	10	770	$180	$166.6K

Showing 1–10 of 91

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Goodwill Industries Of Northern New England	ME	Comprehensive Outpatient Rehabilitation Facility (CORF)	$0	$106M
Maine Vocational Associates, Inc.	ME	Developmentally Disabled Services Day Training Agency	$0	$34.3M
Catholic Charities Maine	ME	Clinical Social Worker	$0	$17.7M
Spurwink Services Incorporated	ME	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$16.8M
Milestone Recovery	ME	Substance Abuse Rehabilitation Facility	$0	$8.8M
Portland Community Health Center	ME	Federally Qualified Health Center (FQHC)	$0	$7.4M
Black Bear Medical, Inc.	ME	Customized Equipment (DME)	$0	$7.4M
Usa Family Well Being Services LLC	ME	Community/Behavioral Health Agency	$0	$6.3M
City Of Portland	ME	Land Ambulance	$740.2K	$5.4M
Maine Behavioral Healthcare	ME	Community/Behavioral Health Agency	$0	$4.9M

Mainehealth — Billing Profile & Reimbursement Data

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Mainehealth — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mainehealth	ME	General Acute Care Hospital	$0	$142.6M
Mainehealth	ME	Community/Behavioral Health Agency	$0	$115M
Mainehealth	ME	General Acute Care Hospital	$0	$70.7M
Mainehealth	ME	General Acute Care Hospital	$0	$40M
Mainehealth	ME	General Acute Care Hospital	$0	$31.5M
Mainehealth	ME	General Acute Care Hospital	$0	$22.7M
Mainehealth	ME	Rural Health Clinic/Center	$0	$16.7M
Mainehealth	ME	Multi-Specialty Clinic/Center	$0	$10.9M
Mainehealth	ME	Rural Health Clinic/Center	$0	$10M
Mainehealth	ME	Rural Health Clinic/Center	$0	$9.8M