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

Why is the Medicaid comparison limited to New Jersey 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. New Jersey (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.

Coastal Ear Nose And Throat, LLC (NPI 1861592867)

Coastal Ear Nose And Throat, LLC is a otolaryngology physician provider located in Neptune, New Jersey. This profile covers 0 Medicare and 42 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	Coastal Ear Nose And Throat, LLC
Address	3700 Route 33
City	Neptune
State	NJ
ZIP	07753
Taxonomy	Otolaryngology Physician
NPI Enumerated	September 22, 2006

Payer Source	Total Paid
Medicaid	$13.3M
Medicare	$0

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

42 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	41,560	$80	$3.4M
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…	15,540	$110	$1.7M
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	7,230	$200	$1.4M
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	8,760	$150	$1.3M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	4,630	$280	$1.3M
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…	4,030	$200	$797.5K
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…	6,330	$120	$772.7K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	8,760	$60	$490.3K
31575	The provider uses a flexible laryngoscope to look inside the larynx, or voice box, to detect the presence of any abnormalities. This code applies to diagnostic services.	3,070	$130	$390.1K
92504	In this diagnostic procedure, the provider uses a microscope to examine the ears of a patient. He may also sometimes examine the patient’s nose for direct visualization to help with diagnosis…	10,270	$30	$308.1K

Showing 1–10 of 42

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Jersey Distribution

Coastal Ear Nose And Throat, LLC — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Jersey

Full comparison — all codes billed, vs. New Jersey median

42 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
31237	In this procedure, the provider inserts an endoscope into the nasal cavity. She examines the nasal contents. The provider then performs a nasal biopsy, polypectomy, or debridement.	3	10	80	$350	$403.6K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	2	30	290	$590	$379.3K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	5	30	150	$1,170	$313.7K
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	3	50	460	$150	$285.7K
92524	The provider, typically a speech language pathologist, evaluates a patient for the quality of voice, nasality, and vocal behavior of the patient.	4	10	2,600	$50	$238.3K
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…	97	4,450	740	$40	$229.8K
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…	402	3,790	580	$60	$204K
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	4	10	120	$560	$172.8K
92579	The provider performs a battery of tests to evaluate hearing loss in infants and toddlers. He uses sound sources to evaluate the auditory response, with reinforcement by animated toys.	8	30	870	$150	$159.3K
31579	The provider uses a flexible or rigid laryngoscope to look inside the larynx, or voice box, to detect the presence of any abnormalities. He also performs stroboscopy, which is a method of examination…	4	10	220	$190	$143.4K

Showing 1–10 of 42

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sean Houston	NJ	Otolaryngology Physician	$167.3K	$0
Seth Silberman	NJ	Otolaryngology Physician	$163K	$0
Jacob Mcafee	PA	Otology & Neurotology Physician	$157.8K	$0
Josef Shargorodsky	MA	Otolaryngology Physician	$150.6K	$0
Qasim Husain	NJ	Otolaryngology Physician	$144.4K	$0
Kenneth Newkirk	DC	Otolaryngology Physician	$125K	$0
Victoria Bones	NJ	Otolaryngology Physician	$90.1K	$0
Mursalin Anis	FL	Otolaryngology Physician	$46.2K	$0
Amy Wilson	NJ	Audiologist	$23.5K	$0
Kristen Campbell	VT	Audiologist	$2.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hmh Hospitals Corporation	NJ	General Acute Care Hospital	$0	$128.2M
Children's Center Programs, LLC	NJ	Developmentally Disabled Services Day Training Agency	$0	$44.6M
Nj Certified Dermatology PC	NJ	Dermatology Physician	$0	$14.9M
Preferred Home Healthcare & Nursing Services, Inc.	NJ	Home Health Agency	$0	$13M
Jsas Healthcare, Inc.	NJ	Methadone Clinic	$480K	$12.3M
Neptune Adult Day Health Center, Inc.	NJ	Adult Day Care Clinic/Center	$0	$12.5M
Meridian Hospitals Corporation	NJ	General Acute Care Hospital	$0	$11.8M
Morning Glory Behavioral Health Partial Care Program LLC	NJ	Adult Mental Health Clinic/Center	$0	$10M
Alternative Counseling Method LLC	NJ	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$9.9M
Aba Solutions LLC	NJ	Behavior Analyst	$0	$8.8M

Coastal Ear Nose And Throat, LLC — Billing Profile & Reimbursement Data

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Coastal Ear Nose And Throat, LLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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