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 1982645305)

Key Findings

Field	Value
Entity Type	Organization
Organization	Mainehealth
Address	6 Glen Cove Dr
City	Rockport
State	ME
ZIP	04856
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 9, 2006

Payer Source	Total Paid
Medicaid	$31.5M
Medicare	$0

MAINEHEALTH reports no Medicare revenue on file and $31.5M in lifetime Medicaid revenue, meaning its public-payer footprint in this dataset is effectively single‑payer Medicaid rather than a mixed Medicare/Medicaid profile. The absence of Medicare billing limits cross‑payer benchmarking and indicates analysts should treat this entity as Medicaid‑centric for revenue and utilization comparisons.

Revenue is highly concentrated in a small set of outpatient and emergency codes: the precomputed top three Medicaid codes account for 63.5% of the provider's total Medicaid revenue. Those top three are G0463 ($10.8M, 42.9%), 99284 ($3.6M, 14.3%), and 99285 ($1.6M, 6.3%), signaling a small number of services drive the majority of Medicaid dollars.

The code mix points to a hospital that operates a high‑volume outpatient clinic and an active emergency department. G0463 (157K claims, $10.8M) is the single largest revenue driver and is described as a hospital outpatient clinic visit for assessment and management, while ED E/M codes 99284 (19.5K claims, $3.6M) and 99285 (4.8K claims, $1.6M) together represent substantial ED throughput and higher‑acuity emergency care.

On statewide competitive standing for its top revenue drivers, MAINEHEALTH is a solid participant but not a dominant outlier. G0463 ranks #10 of 55 in‑state (83th percentile, described as "typical, unremarkable volume for this code"), 99284 ranks #20 of 61 (68th percentile, "typical, unremarkable volume for this code"), and 99285 ranks #27 of 56 (53th percentile, "typical, unremarkable volume for this code").

Beyond the top three codes, the provider shows broad ancillary and outpatient service lines that contribute materially to Medicaid revenue. High claim counts and revenues appear in diagnostic imaging (74177 $441.6K; 71046 $277.4K), outpatient procedures (43239 $414.7K; 45385 $273.4K), infusion/administration services (96374 $706.4K; 96365 $341.1K), and inpatient/clinic therapy codes (97110 $378.3K; 97530 $367.6K), indicating integrated imaging, infusion, and rehabilitation capacity.

Certain service lines register above‑typical statewide volumes and stand out operationally. Vaccination services 90471 (13.9K claims, $528.1K) and neuromuscular reeducation 97112 (9.5K claims, $274.7K) are both flagged as "notably above typical state volume for this code," suggesting stronger pediatric/preventive and rehab throughput than many peers; other high‑volume codes like 92507 (15.2K claims, $652.7K) are described as "typical, unremarkable volume for this code" despite high claim counts.

The predominance of outpatient clinic visits (G0463) combined with multiple ED E/M codes (99282–99285 series) and substantial counts for infusion and chemotherapy administration (96374, 96365, 96413) imply operational emphasis on emergency care, same‑day/observation outpatient services, and ambulatory infusion/oncology support. This mix is consistent with a general acute care hospital that routes a large share of Medicaid patients through its ED and outpatient clinic pathways.

MAINEHEALTH has an established operating history with an NPI enumerated on 2006-06-09 (~20 years ago), but the data limitation of having no Medicare billing on file means analysts should avoid national Medicare benchmarking and instead compare the provider primarily to in‑state Medicaid peers when evaluating competitive position and utilization patterns.

Medicaid: Complete Services Breakdown

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

416 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	157,020	$70	$10.8M
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.	19,490	$190	$3.6M
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.	4,770	$330	$1.6M
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.	11,100	$130	$1.5M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	6,790	$100	$706.4K
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.	7,720	$90	$664.3K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	15,180	$40	$652.7K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	13,900	$40	$528.1K
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.	3,620	$120	$441.6K
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.	1,250	$330	$414.7K

Showing 1–10 of 416

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

416 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	10	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.	20	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.	27	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.	30	50	11,590	$60	$942.4K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	14	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.	18	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…	8	30	880	$110	$338.4K
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.	10	30	200	$250	$316.8K
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.	14	40	5,020	$40	$302.3K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	19	40	3,970	$60	$299.5K

Showing 1–10 of 416

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bfli	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$39.6M
Knox County Homeless Coalition	ME	Case Management Agency	$0	$4.5M
Mainehealth	ME	General Acute Care Hospital	$0	$4.3M
Penobscot Bay Physicians & Associates	ME	Multi-Specialty Clinic/Center	$0	$414.6K
John Mamon	ME	Diagnostic Radiology Physician	$105.3K	$194.5K
Kerry Lavigne	ME	MOHS-Micrographic Surgery Physician	$268K	$0
Robert Fisher	ME	Urology Physician	$225.8K	$0
Nancy Coyne	ME	Physical Therapist	$174.3K	$0
Eric Elton	ME	Gastroenterology Physician	$92.5K	$730
Maine Molecular Imaging, LLC	ME	Diagnostic Radiology Physician	$80.1K	$0

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

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	$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