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 West Virginia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Tri-state Community Health Center, Inc (NPI 1083055081)

Tri-state Community Health Center, Inc is a federally qualified health center (fqhc) provider located in Berkeley Springs, West Virginia. This profile covers 0 Medicare and 20 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	Tri-state Community Health Center, Inc
Address	261 Berkmore Pl
City	Berkeley Springs
State	WV
ZIP	25411
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	July 8, 2013

Payer Source	Total Paid
Medicaid	$1.7M
Medicare	$0

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

20 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	14,130	$110	$1.5M
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…	7,060	$10	$77.6K
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…	6,010	$10	$54.1K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	2,690	$10	$24.2K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,000	$10	$11K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	260	$30	$6.5K
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	580	$10	$5.2K
81003	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dipstick, and shakes off the excess urine. She places the stick onto a mechanical dip stick reader that will…	160	$20	$3K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	1,920	$1	$1.9K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	230	$10	$1.6K

Showing 1–10 of 20

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Tri-state Community Health Center, Inc — 0 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

20 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	120	390	4,610	$130	$2.2M
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…	266	1,270	1,240	$30	$245K
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…	155	1,030	890	$50	$221K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	148	330	790	$10	$64.1K
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,…	476	540	320	$20	$43.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	171	190	220	$50	$42.7K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	200	310	490	$20	$42K
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	136	140	900	$10	$38.3K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	167	200	360	$20	$26K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	33	90	190	$20	$26K

Showing 1–10 of 20

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tri-state Community Health Center, Inc	MD	Federally Qualified Health Center (FQHC)	$0	$5.8M
Raymond Banfer	MD	Family Medicine Physician	$10.5K	$72.9K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
War Memorial Hospital, Inc.	WV	Critical Access Hospital	$0	$4.6M
Senior Life Services Of Morgan County, Inc.	WV	Home Health Agency	$0	$2.7M
Rankin Physical Therapy LLC	WV	Physical Therapist	$0	$2.2M
Morgan County Rescue Service Inc	WV	Land Ambulance	$210.4K	$884.7K
War Memorial Hospital, Inc.	WV	Critical Access Hospital	$0	$1.1M
War Memorial Hospital, Inc.	WV	Rural Health Clinic/Center	$0	$751.9K
Andrew Berens	WV	Family Medicine Physician	$187.2K	$0
Arin Longfellow	WV	Adult Health Nurse Practitioner	$161.4K	$0
Misty Householder	WV	Physical Therapist	$99.6K	$0
Amanda Michael	WV	Family Medicine Physician	$72K	$0

Tri-state Community Health Center, Inc — Billing Profile & Reimbursement Data

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Tri-state Community Health Center, Inc — 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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