Loading...
NPI 1265907885 · Ada, OK · Ambulatory Surgical Clinic/Center
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Apex Surgery Center, LLC is a ambulatory surgical clinic/center provider located in Ada, Oklahoma. This profile covers 15 Medicare and 4 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Apex Surgery Center, LLC |
| Address | 2001 Cradduck Road |
| City | Ada |
| State | OK |
| ZIP | 74820 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | October 10, 2018 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.9M |
| Medicaid | $1.2M |
APEX SURGERY CENTER, LLC operates as an ambulatory surgical clinic with a mixed procedural footprint: its Medicare mix is driven by ophthalmology (66984 cataract extraction/IOL insertion) and multiple neurostimulation implant procedures (64590, 63685, 64561, 64581), while its Medicaid billing is dominated by pediatric and ENT procedures (42820 tonsil/adenoid removal and 69436 tympanostomy). The presence of high-reimbursement implant codes alongside routine ophthalmic and ENT codes indicates an ASC that supports both device implantation and high-volume outpatient ENT/ophthalmology workflows.
Medicare revenue at this provider totals $1.9M, and the top three Medicare codes account for 51.5% of that Medicare revenue. The single largest Medicare code is 66984 (523 claims, $759 avg paid/claim, $397K revenue; 20.6% of Medicare revenue) followed by high-value implant code 64590 ($374.7K; 19.4%) and 63685 ($222.2K; 11.5%), so over half of Medicare dollars come from a concentrated set of ophthalmology and neurostimulator implant services.
Medicaid revenue totals $1.2M, and Medicaid is heavily concentrated in a very small set of procedures: the top three Medicaid codes represent 93.6% of Medicaid revenue. Code 42820 (tonsil/adenoid removal) alone contributes $689K (59.0% of Medicaid revenue) and 69436 (tympanostomy) contributes $311.6K (26.7%), indicating the provider is effectively operating as a regional pediatric/ENT hub for Medicaid patients.
The provider’s payer mix shows a meaningful presence in both government programs but skews slightly toward Medicare by dollars ($1.9M Medicare vs. $1.2M Medicaid). This indicates the ASC serves a mixed-age patient population and is not effectively single‑payer; operationally, the center needs capabilities and staffing to support both adult-focused ophthalmology/implant procedures and high-volume pediatric ENT cases.
On national competitiveness for Medicare codes the provider is mixed: 66984 ranks #2838 of 15965 (82th percentile; typical, unremarkable volume for this code), which suggests routine cataract volume for an ASC, while neurostimulator-related codes show comparatively stronger national standing — for example, 64590 ranks #90 of 561 (83th percentile; typical, unremarkable volume) and 64561 ranks #73 of 564 (87th percentile; typical, unremarkable volume). Notably, 64581 ranks #6 of 91 (92th percentile; typical, unremarkable volume for this code), signaling a relatively prominent position nationally for that specific sacral electrode implantation service.
In-state competitive positioning on Medicaid indicates the ASC is a leading local provider for some pediatric/ENT services: 69436 ranks #16 of 69 (78th percentile; typical, unremarkable volume) and 42820 ranks #16 of 53 (71th percentile; typical, unremarkable volume), while 30802 ranks #1 of 2 (100th percentile; typical, unremarkable volume for this code) — the latter reflects dominance but in a very small comparison set. These ranked positions suggest the center competes effectively for common pediatric ENT procedures within Oklahoma but is not a statewide monopoly.
Tenure is modest: the NPI was enumerated on 2018-10-10 (~8 years ago), indicating the facility has had several years to establish referral patterns and payer relationships. That timeframe is consistent with the development of both a routine cataract and pediatric ENT referral base as reflected in the billing mix.
Statistically, the dataset shows concentration but few extreme outliers: most listed codes are described as "typical, unremarkable volume for this code," and no code is flagged as an extreme outlier in the provided summaries. The operational implication is that while revenue is concentrated in a few high-value codes (see the 51.5% Medicare and 93.6% Medicaid top‑3 concentrations), these are generally within expected volume ranges versus peers rather than anomalous billing patterns.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
15 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 66984 | The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to… | 520 | $760 | $397K |
| 64590 | The provider inserts or replaces a peripheral, sacral, or gastric neurostimulator pulse generator or receiver. The system is one that requires surgical creation of a pocket for placement and that… | 30 | $13,380 | $374.7K |
| 63685 | The provider inserts or replaces a spinal neurostimulator pulse generator or receiver. The system is one that requires surgical creation of a pocket for placement and that requires a connection… | 10 | $17,090 | $222.2K |
| 64561 | The provider, under imaging guidance, implants electrodes around nerves in the sacral region to reduce the pain along the path of the nerve. | 60 | $3,450 | $220.9K |
| C9740 | Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants | 40 | $4,990 | $174.7K |
| 27447 | In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The… | 30 | $6,300 | $170.1K |
| J1097 | phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | 1,890 | $80 | $143.5K |
| 64581 | The provider uses an open approach to implant a sacral nerve neurostimulator electrode array. Placement is transforaminal, meaning through the foramen (the opening sacral nerves run through). This… | 30 | $3,690 | $95.9K |
| 52601 | During transurethral resection of the prostate (TURP), the surgeon inserts a resectoscope via the urethra and removes a portion of the prostate. This procedure includes several other urological… | 20 | $1,560 | $34.3K |
| 15823 | In this procedure, the provider surgically trims excessive skin that weighs down the upper eyelid, typically to improve the cosmetic appearance of the face and due to the interference of the tissue… | 70 | $460 | $33K |
Showing 1–10 of 15
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
15 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63685 | 21 | 30 | 20 | $7,450 | $238.5K |
| C9740 | 1 | 10 | 30 | $5,080 | $127K |
| J1097 | 1 | 10 | 1,410 | $80 | $111.4K |
| 64590 | 4 | 30 | 20 | $4,440 | $88.8K |
| 66984 | 26 | 350 | 40 | $430 | $69.3K |
| 64561 | 2 | 20 | 20 | $1,750 | $54.2K |
| 15823 | 14 | 40 | 50 | $510 | $39.7K |
| 27447 | 100 | 180 | 30 | $730 | $35.2K |
| 66982 | 23 | 60 | 30 | $590 | $27.1K |
| 64581 | 2 | 10 | 20 | $1,180 | $23.6K |
Showing 1–10 of 15
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 340 | $2,000 | $689K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 950 | $330 | $311.6K |
| 66984 | The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to… | 210 | $450 | $91.9K |
| 30802 | In this procedure, the provider uses methods like bipolar cautery, reducing the tissue volume, radiofrequency, or somnoplasty to perform ablation of the submucosal area of the inferior turbinates. | 340 | $220 | $75.3K |
How this provider's Medicaid billing volume and revenue compare to other Oklahoma providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Oklahoma median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 16 | 50 | 70 | $1,800 | $496.5K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 16 | 70 | 150 | $450 | $279K |
| 66984 | The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to… | 17 | 40 | 170 | $340 | $211.6K |
| 30802 | In this procedure, the provider uses methods like bipolar cautery, reducing the tissue volume, radiofrequency, or somnoplasty to perform ablation of the submucosal area of the inferior turbinates. | 1 | 10 | 310 | $160 | $49.5K |
Other providers in the same ZIP code as Apex Surgery Center, LLC, ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.