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 1932164795)

Field	Value
Entity Type	Organization
Organization	Mainehealth
Address	123 Medical Center Dr
City	Brunswick
State	ME
ZIP	04011
Taxonomy	General Acute Care Hospital
NPI Enumerated	April 17, 2006

Payer Source	Total Paid
Medicaid	$40M
Medicare	$0

Key Findings

This entity has no Medicare billing on file and reports $40M in lifetime Medicaid revenue, so the dataset captures it effectively as a Medicaid-funded facility rather than a dual-payer operator. The absence of Medicare activity in the file means downstream comparisons to national Medicare peers are not possible for this provider.

Revenue is highly concentrated: the top three Medicaid codes account for 67.2% of this provider's total Medicaid revenue. Those top contributors are G0463 ($12.1M, 37.8%), 99285 ($5M, 15.7%), and 99284 ($4.4M, 13.8%), indicating a small set of services drive most Medicaid dollars.

The code mix points to a hospital that operates substantial outpatient clinic and emergency department capacity: G0463 is the single largest revenue line (hospital outpatient clinic visits), and high-acuity ED codes 99285 and 99284 are the next-largest drivers. In addition to acute ED throughput, the provider also bills materially for infusion/IV administration (96374, 96365, 96361, 96360) and diagnostic throughput (74177, 71046, 93306), which is consistent with a general acute care hospital doing both ED and ambulatory procedures.

Competitively within Maine the provider is a solid mid-to-high performer on its top clinic and ED lines but not the clear statewide leader: G0463 ranks #8 of 55 providers in-state (87th percentile; typical, unremarkable volume for this code), 99285 ranks #21 of 56 (64th percentile; typical, unremarkable volume), and 99284 ranks #17 of 61 (73th percentile; typical, unremarkable volume). These ranks suggest meaningful market share for routine outpatient clinic and ED work, but the provider is not a dominant outlier across those categories.

Several outpatient and ancillary service lines show above-typical or notable state-level volumes that diversify the revenue base beyond ED/clinic visits. Physical therapy codes 97110 (22.6K claims, $496.8K revenue) and 97140 (16.5K claims, $279.8K revenue) are at the 95th and 96th percentiles respectively (97110: ranks #8 of 145 providers in-state; 97140: ranks #5 of 94), and immunization work (90471; 12.4K claims, $446.2K, 95th percentile) is also notably above typical state volume — collectively these indicate a significant outpatient rehab and preventive-care footprint.

The provider shows clustered high-volume behavioral health and lab screening activity that aligns with broader outpatient behavioral health services: 90853 (14.6K claims, $1.1M revenue) sits at the 95th percentile (ranks #3 of 42) and presumptive drug testing 80307 (16.9K claims, $236.7K) is at the 95th percentile (ranks #3 of 40). These positions suggest the hospital is a regional node for group psychotherapy and substance-use–related screening services.

There are clear in-state outliers in a few procedural codes that indicate specialized procedural capacity: 64450 ($271.5K, ranks #1 of 6 providers in-state, 100th percentile; notably above typical state volume for this code) is an extreme local outlier and points to concentrated capability in peripheral nerve injections. Other higher-than-typical procedure volumes (e.g., J0585, 93306, 43239) further show the hospital performs a range of specialty outpatient procedures at meaningful scale.

This provider has a long enrollment history (NPI enumerated 2006-04-17 (~20 years ago)), which, combined with the concentrated Medicaid revenue patterns, suggests an established regional provider whose core revenue is anchored in outpatient clinic assessments, emergency care, PT/rehab, and select high-volume ancillary services rather than broad Medicare-facing inpatient billing 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.

459 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	166,330	$70	$12.1M
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.	8,900	$570	$5M
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.	21,350	$210	$4.4M
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.	12,430	$140	$1.7M
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	14,600	$70	$1.1M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	10,080	$100	$1M
J0585	Injection, onabotulinumtoxina, 1 unit	1,240	$540	$667.7K
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.	3,390	$160	$525.8K
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.	5,860	$90	$509.9K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	22,580	$20	$496.8K

Showing 1–10 of 459

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 — 4 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

459 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	8	60	18,740	$60	$4.6M
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.	17	60	9,550	$100	$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.	21	60	4,690	$180	$1.5M
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.	26	50	11,590	$60	$942.4K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	7	10	200	$1,690	$796.1K
J0585	Injection, onabotulinumtoxina, 1 unit	8	20	1,240	$380	$618.9K
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	30	1,440	$160	$515.5K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	8	30	6,230	$70	$515.4K
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.	19	60	2,380	$90	$345.7K
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…	15	30	880	$110	$338.4K

Showing 1–10 of 459

Related Providers

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

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	$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
Mainehealth	ME	Rural Health Clinic/Center	$0	$9.6M

Nearby Providers

Other providers in the same ZIP code as Mainehealth, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Volunteers Of America Northern New England	ME	Mental Illness Community Based Residential Treatment Facility	$0	$58.2M
Independence Association, Inc	ME	Developmentally Disabled Services Day Training Agency	$0	$57.9M
Pathways Of Maine, LLC	ME	Community/Behavioral Health Agency	$0	$22.3M
Bluewater Emergency Partners Of Brunswick, LLC	ME	Emergency Medicine Physician	$0	$3.8M
Pathways Of Maine, Inc.	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$3.7M
Lawrence Bossong	ME	Oral and Maxillofacial Surgery (Dentist)	$0	$3.7M
Mainehealth	ME	Multi-Specialty Clinic/Center	$0	$2.8M
Pathways Of Maine, Inc.	ME	Community/Behavioral Health Agency	$0	$2.7M
Guardian Pharmacy Of Maine, LLC	ME	Long Term Care Pharmacy	$162.2K	$2.4M
Town Of Brunswick	ME	Land Ambulance	$386.5K	$1.4M

Mainehealth — Billing Profile & Reimbursement Data

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Mainehealth — 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