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.

Physicians For Women's Health LLC (NPI 1801826680)

Key Findings

Field	Value
Entity Type	Organization
Organization	Physicians For Women's Health LLC
Address	175 Capital Blvd Ste 300
City	Rocky Hill
State	CT
ZIP	06067
Taxonomy	Obstetrics & Gynecology Physician
NPI Enumerated	July 4, 2006

Payer Source	Total Paid
Medicaid	$57.3M
Medicare	$0

This provider is effectively single‑payer Medicaid: there is no Medicare billing on file and lifetime Medicaid revenue is $57.3M, indicating the practice’s billed activity is concentrated in the Medicaid population rather than split across Medicare/Medicaid. Analysts should treat Medicaid as the primary commercial footprint for payer contracting and utilization analysis.

Revenue concentration is substantial in a small set of services: the precomputed top 3 Medicaid codes by revenue account for 35.6% of the provider’s total Medicaid revenue. Those three codes are 81420 (12.6K claims, $465 avg paid/claim, $5.9M revenue (12.7% of this provider's total Medicaid revenue)), 99213 (142.1K claims, $38 avg paid/claim, $5.4M revenue (11.7%)), and 87491 (160.3K claims, $32 avg paid/claim, $5.1M revenue (11.1%)).

The code mix and top revenue drivers indicate an OB/GYN practice that performs high volumes of reproductive health screening and prenatal care: high‑revenue molecular and infectious disease tests (81420, 87491, 87591, 87624), cervical cytology (88175), and obstetric imaging (76830, 76811, 76801) appear repeatedly among top codes. The presence of 81420 (cell‑free fetal DNA) alongside multiple ultrasound codes and high volumes of well visits implies they offer both advanced prenatal screening and routine obstetric/gynecologic ambulatory care.

On competitive standing within Connecticut, the provider frequently ranks at or near the top for many gynecologic and infectious disease screening codes. Examples include 87491 (ranks #2 of 49, 98th percentile; labeled an "extreme outlier, far above typical state volume"), 99213 (ranks #18 of 1714, 99th percentile; "extreme outlier"), and numerous codes ranked #1 in‑state at the 100th percentile (e.g., 87624, 88175, 99395), which together show the practice is a major statewide contributor for routine OB/GYN visits and laboratory screening.

The provider shows an operational emphasis on large‑scale lab testing and STI/HPV screening. High volumes and revenues appear for paired STD/HPV molecular tests such as 87491 (160.3K claims, $5.1M), 87591 (160.2K claims, $5.1M), 87624 (104.7K claims, $3M), and 87389 (79.9K claims, $1.7M), many of which are characterized as "extreme outlier" or ranked #1 in‑state. This pattern is consistent with standardized screening workflows (rapid NAAT testing and HPV assays) and suggests substantial throughput of specimens or centralized test ordering.

Prenatal and imaging services contribute meaningfully to revenue and reinforce an obstetrics capacity: 76830 (26.9K claims, $57 avg, $1.5M revenue (3.3%)) ranks #1 of 89 providers (100th percentile; extreme outlier), and 76811 (3.1K claims, $229 avg, $719.1K revenue (1.6%)) and 76801 (5.5K claims, $119 avg, $653.5K revenue (1.4%)) are also present in the top 25. Coupled with the substantial revenue from 81420 (cfDNA testing), these entries indicate both routine and higher‑complexity prenatal services are a visible part of the practice’s Medicaid portfolio.

Preventive and routine office care are also major volume drivers: 99213 (142.1K claims, $38 avg, $5.4M) and well visit codes 99395 (33.3K claims, $52 avg, $1.7M) and 99396 (13K claims, $58 avg, $755.5K) appear prominently; 99395 ranks #1 of 145 providers (100th percentile; extreme outlier). This mix demonstrates that the practice handles large numbers of established patient visits and wellness exams in addition to lab and obstetric services, supporting a high ambulatory visit throughput model.

The NPI tenure (enumerated 2006-07-04, ~20 years ago) indicates this is an established practice with long‑standing presence in the market. Combined with the concentrated Medicaid revenue stream and repeated top‑percentile rankings, the tenure supports an interpretation of sustained, high‑volume Medicaid operations rather than a recent or transient billing spike.

Medicaid: Complete Services Breakdown

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

147 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	12,630	$470	$5.9M
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…	142,120	$40	$5.4M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	160,340	$30	$5.1M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	160,160	$30	$5.1M
87624	The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result.	104,700	$30	$3M
81513	The lab analyst performs the technical lab test on a vaginal fluid specimen for quantitative real–time amplification of RNA markers for three bacterial species listed in the code descriptor, and…	23,800	$90	$2.1M
88175	The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer…	140,280	$10	$2M
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	33,320	$50	$1.7M
87389	The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an…	79,910	$20	$1.7M
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	26,890	$60	$1.5M

Showing 1–10 of 147

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

Physicians For Women's Health LLC — 18 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

147 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	1	10	4,900	$390	$2.2M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	17	50	3,340	$60	$1M
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	6	50	1,820	$100	$515.7K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	11	30	1,560	$160	$444.1K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	13	90	3,980	$40	$424.8K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	2	50	4,240	$30	$410.4K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	2	50	4,240	$30	$409.9K
87800	The lab analyst performs a test for multiple infectious organisms in one sample using direct nucleic acid probe technique.	1	10	2,270	$40	$387.6K
77067	The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software…	39	80	3,260	$70	$376.2K
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…	106	1,590	740	$50	$331.8K

Showing 1–10 of 147

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Caitlin Lopez	MA	Diagnostic Radiology Physician	$361.8K	$3.6K
Mia Jackson	FL	Diagnostic Radiology Physician	$221.5K	$0
Donna Rose	CT	Anatomic Pathology & Clinical Pathology Physician	$166.3K	$0
Adine Regan	CT	Urology Physician	$141.4K	$0
Joshua Russell	MA	Internal Medicine Physician	$133.3K	$1.5K
Lisa Laird	CT	Anatomic Pathology & Clinical Pathology Physician	$112.7K	$0
Phoebe Freer	MO	Diagnostic Radiology Physician	$64.1K	$0
Saverio Ligato	CT	Anatomic Pathology Physician	$60.5K	$0
Marcia Tejeda	CT	Obstetrics & Gynecology Physician	$57.6K	$0
Gary Besser	CT	Obstetrics & Gynecology Physician	$50.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
New England Home Care Inc.	CT	Home Health Agency	$0	$397.1M
Priority Care, Inc.	CT	Home Health Agency	$0	$53.5M
Starling Physicians, PLLC	CT	Internal Medicine Physician	$0	$38.1M
Connecticut Addiction Medicine, LLC	CT	Addiction Psychiatry Physician	$0	$21.1M
Atg Connecticut Inc	CT	Customized Equipment (DME)	$0	$19.9M
Centerwell Certified Healthcare Corp.	CT	Home Health Agency	$0	$17M
Masters In Home Care, LLC	CT	Home Health Agency	$0	$10M
Mc Diagnostic Of Connecticut, P.C.	CT	Family Nurse Practitioner	$0	$4.7M
Rocky Hill Surgery Center, LLC	CT	Ambulatory Surgical Clinic/Center	$1.3M	$254.9K
Rocky Hill Public Schools	CT	Local Education Agency (LEA)	$0	$1.4M

Physicians For Women's Health LLC — 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