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PROSPECT CT MEDICAL FOUNDATION, INC.

Family Medicine·MANCHESTER, CT·NPI: 1144677568Share

Compared to Family Medicine Peers

Total spending distribution among 19 providers in this specialty

P25MedianP75P90

This provider's total spending of $34.1M is at the 75th percentile among 19 Family Medicine providers.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$34.1M

$34,066,589

Total Claims

1.3M

Beneficiaries

1.1M

1.2 claims/patient

Avg Cost/Claim

$25

Monthly Spending Trend

Yearly Spending

2018
$5.1M
+9%
2019
$5.5M
-22%
2020
$4.3M
+13%
2021
$4.9M
+5%
2022
$5.1M
-8%
2023
$4.8M
-9%
2024
$4.3M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 50 distinct procedure codes. The top code (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 30% of total spending.

99214Normal range

Office/outpatient visit, est. patient, mod-high complexity

$10.3M

197K claims · 30.3%

Your Cost: $52.42/claim|Median: $53.41
1.0× median
99213Normal range

Office/outpatient visit, est. patient, low-mod complexity

$8.1M

197K claims · 23.8%

Your Cost: $41.28/claim|Median: $37.81
1.1× median
J0585Normal range

Injection, onabotulinumtoxinA, 1 unit

$1.5M

3,620 claims · 4.5%

Your Cost: $420.16/claim|Median: $470.36
0.9× median
99232Normal range

Subsequent hospital care, per day, moderate complexity

$973K

49K claims · 2.9%

Your Cost: $19.71/claim|Median: $23.99
0.8× median
99391Top 10%

Preventive medicine, established patient, infant (under 1)

$929K

8,238 claims · 2.7%

Your Cost: $112.76/claim|Median: $69.35
1.6× median
90460Top 25%

Immunization administration, first vaccine/toxoid, with counseling

$898K

25K claims · 2.6%

Your Cost: $35.81/claim|Median: $17.85
2.0× median
99392Top 10%

Preventive medicine, established patient, age 1-4

$840K

7,291 claims · 2.5%

Your Cost: $115.17/claim|Median: $75.18
1.5× median
99284Normal range

Emergency dept visit, high complexity

$739K

15K claims · 2.2%

Your Cost: $48.38/claim|Median: $69.51
0.7× median
99285Normal range

Emergency dept visit, high/urgent complexity

$724K

11K claims · 2.1%

Your Cost: $67.12/claim|Median: $85.65
0.8× median
99393Top 10%

Preventive medicine, established patient, age 5-11

$464K

4,227 claims · 1.4%

Your Cost: $109.85/claim|Median: $74.82
1.5× median
99233Normal range

Subsequent hospital care, per day, high complexity

$452K

18K claims · 1.3%

Your Cost: $25.62/claim|Median: $35.30
0.7× median
99215Normal range

Office/outpatient visit, high complexity

$428K

7,373 claims · 1.3%

Your Cost: $58.09/claim|Median: $74.09
0.8× median
90791Normal range

Psychiatric diagnostic evaluation

$412K

14K claims · 1.2%

Your Cost: $30.03/claim|Median: $99.21
0.3× median
99308Top 25%

Nursing facility care, subsequent, straightforward

$378K

16K claims · 1.1%

Your Cost: $23.75/claim|Median: $9.79
2.4× median
99231Normal range

Subsequent hospital care, per day, low complexity

$362K

25K claims · 1.1%

Your Cost: $14.60/claim|Median: $16.77
0.9× median
99394Top 25%

Preventive medicine, established patient, age 12-17

$323K

3,023 claims · 0.9%

Your Cost: $106.75/claim|Median: $80.15
1.3× median
99239Normal range

Hospital discharge day management, more than 30 minutes

$320K

10K claims · 0.9%

Your Cost: $30.69/claim|Median: $43.85
0.7× median
93306Normal range

Echocardiography, transthoracic, complete, with Doppler

$278K

6,077 claims · 0.8%

Your Cost: $45.75/claim|Median: $54.68
0.8× median
99223Normal range

Initial hospital care, per day, high complexity

$262K

5,744 claims · 0.8%

Your Cost: $45.69/claim|Median: $67.32
0.7× median
93010Normal range

Electrocardiogram, interpretation and report only

$258K

73K claims · 0.8%

Your Cost: $3.52/claim|Median: $5.60
0.6× median
99395Normal range

Preventive medicine, established patient, age 18-39

$245K

3,865 claims · 0.7%

Your Cost: $63.32/claim|Median: $72.71
0.9× median
99305Top 10%

$238K

3,757 claims · 0.7%

Your Cost: $63.31/claim|Median: $19.28
3.3× median
99283Normal range

Emergency dept visit, moderate complexity

$235K

8,981 claims · 0.7%

Your Cost: $26.16/claim|Median: $42.48
0.6× median
96110Top 25%

Developmental screening, per standardized instrument

$210K

9,407 claims · 0.6%

Your Cost: $22.31/claim|Median: $9.10
2.5× median
99204Normal range

Office/outpatient visit, new patient, mod-high complexity

$193K

2,383 claims · 0.6%

Your Cost: $80.84/claim|Median: $84.03
1.0× median
99244Normal range

Office or other outpatient consultation, moderate complexity

$186K

1,626 claims · 0.5%

Your Cost: $114.41/claim|Median: $121.58
0.9× median
99309Top 25%

Nursing facility care, subsequent, low complexity

$147K

3,952 claims · 0.4%

Your Cost: $37.32/claim|Median: $14.00
2.7× median
96127Top 10%

Brief emotional/behavioral assessment, per standardized instrument

$147K

8,633 claims · 0.4%

Your Cost: $17.07/claim|Median: $3.67
4.7× median
76805Top 10%

Ultrasound, pregnant uterus, complete, single fetus

$144K

1,116 claims · 0.4%

Your Cost: $129.37/claim|Median: $74.78
1.7× median
99396Normal range

Preventive medicine, established patient, age 40-64

$127K

1,634 claims · 0.4%

Your Cost: $77.73/claim|Median: $76.06
1.0× median
95810Normal range

Polysomnography, sleep study, 6+ hours

$113K

1,417 claims · 0.3%

Your Cost: $79.43/claim|Median: $233.73
0.3× median
90853Normal range

Group psychotherapy

$112K

7,903 claims · 0.3%

Your Cost: $14.20/claim|Median: $25.02
0.6× median
99442Normal range

Telephone E/M by physician, 11-20 minutes

$106K

5,792 claims · 0.3%

Your Cost: $18.27/claim|Median: $22.44
0.8× median
43239Normal range

Upper GI endoscopy with biopsy

$99K

2,117 claims · 0.3%

Your Cost: $46.95/claim|Median: $151.68
0.3× median
99173Top 25%

$92K

14K claims · 0.3%

Your Cost: $6.79/claim|Median: $2.16
3.1× median
99238Normal range

Hospital discharge day management, 30 minutes or less

$89K

3,642 claims · 0.3%

Your Cost: $24.47/claim|Median: $37.22
0.7× median
99460Normal range

Initial hospital or birthing center care, newborn, per day

$87K

2,524 claims · 0.3%

Your Cost: $34.51/claim|Median: $62.48
0.6× median
99222Normal range

Initial hospital care, per day, moderate complexity

$87K

2,104 claims · 0.3%

Your Cost: $41.39/claim|Median: $51.25
0.8× median
94010Normal range

$84K

10K claims · 0.2%

Your Cost: $8.27/claim|Median: $18.11
0.5× median
87635Normal range

COVID-19 SARS-CoV-2 amplified probe detection

$84K

2,541 claims · 0.2%

Your Cost: $32.89/claim|Median: $39.70
0.8× median
99203Normal range

Office/outpatient visit, new patient, low-mod complexity

$83K

1,685 claims · 0.2%

Your Cost: $49.11/claim|Median: $57.85
0.8× median
92551Normal range

Screening audiometry, pure tone, air only

$79K

14K claims · 0.2%

Your Cost: $5.79/claim|Median: $6.61
0.9× median
45380Normal range

Colonoscopy with biopsy

$76K

958 claims · 0.2%

Your Cost: $78.83/claim|Median: $200.68
0.4× median
64615Normal range

$75K

1,781 claims · 0.2%

Your Cost: $42.00/claim|Median: $82.82
0.5× median
76775Normal range

$72K

2,421 claims · 0.2%

Your Cost: $29.94/claim|Median: $28.03
1.1× median
99443Normal range

Telephone E/M by physician, 21-30 min

$72K

1,927 claims · 0.2%

Your Cost: $37.25/claim|Median: $32.55
1.1× median
99220Normal range

$68K

1,280 claims · 0.2%

Your Cost: $53.11/claim|Median: $73.56
0.7× median
36416Normal range

$66K

25K claims · 0.2%

Your Cost: $2.66/claim|Median: $1.31
2.0× median
98926Normal range

$64K

3,906 claims · 0.2%

Your Cost: $16.36/claim|Median: $22.66
0.7× median
90960Normal range

End-stage renal disease services, per month, age 20+

$59K

854 claims · 0.2%

Your Cost: $68.74/claim|Median: $52.76
1.3× median

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