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 Surgical Center, LLC (NPI 1316025760)

Field	Value
Entity Type	Organization
Organization	Tri-state Surgical Center, LLC
Address	1006 Tavern Rd
City	Martinsburg
State	WV
ZIP	25401
Taxonomy	Ambulatory Surgical Clinic/Center
NPI Enumerated	November 2, 2006

Payer Source	Total Paid
Medicare	$1.3M
Medicaid	$0

Key Findings

Scale and payer mix: TRI-STATE SURGICAL CENTER, LLC reports $1.3M in total Medicare revenue and has no Medicaid billing on file, making its public payer exposure effectively single-payer (Medicare) based on available records. This concentration means analysts should treat Medicare performance as the primary lens for financial and utilization assessment.

Revenue concentration risk: the provider's top three Medicare codes account for 85.0% of its total Medicare revenue, indicating heavy dependence on a very small set of procedures for the bulk of payments. Those top contributors are 27447 ($537.3K, 42.9%), 66984 ($391K, 31.2%), and 27130 ($137.1K, 10.9%), so changes in referral patterns or payment for any of these codes would materially affect revenue.

Service-line profile: the code mix is dominated by major joint arthroplasty and ophthalmology—27447 (knee replacement), 27130 (hip replacement), and 66984 (cataract extraction with intraocular lens) together drive the practice profile. Secondary services on the list (colonoscopies 45380/45385/45378, wrist/hand nerve releases 64721/64718, arthroscopies 29880/29881) point to a mixed ambulatory surgical center that bills for both high-reimbursement orthopedic procedures and routine endoscopy/soft-tissue procedures.

Competitive standing of top codes: although 27447 ranks #1379 of 12089 (88th percentile) and 66984 ranks #2923 of 15965 (82th percentile), both are characterized in the source as "typical, unremarkable volume for this code," which suggests the practice is not an outlier but participates at a common volume level among peers. By contrast, 27130 sits at #4976 of 8062 (35th percentile) and is also labeled "typical, unremarkable volume for this code," indicating more modest participation in hip replacement relative to national providers.

Reimbursement profile by procedure: average payments per claim vary widely across the top procedures, with 27447 averaging $6473 paid/claim and 27130 averaging $6855 paid/claim, while cataract procedures such as 66984 average $782 paid/claim. This spread shows the practice derives similar total dollars from both high-unit-value orthopedic cases and higher-frequency, lower-unit-value ophthalmic cases, reinforcing its dual reliance on those service lines.

Operational tenure: the NPI was enumerated on 2006-11-02 (~20 years ago), indicating the facility has been in the public Medicare billing ecosystem for roughly two decades, which supports the likelihood of established referral and billing practices. Longevity can be a pro for stability but also means historical patterns may persist unless strategic changes are made.

Low Medicaid exposure: there is no Medicaid billing on file for this entity (listed as "none below"), so Medicaid-driven market dynamics, state program changes, or managed-Medicaid contracting will not be visible in this dataset and are unlikely to be direct revenue levers based on current records. Analysts should therefore focus payer-strategy questions and risk assessments on Medicare and any commercial arrangements that are not represented here.

Statistical standing across remaining codes: many secondary CPT/HCPCS entries (for example, 45380, 45385, 29881, 64721 and C9290) are accompanied in the source with labels like "typical, unremarkable volume for this code," and percentile ranks generally cluster around the mid-range. There are no codes labeled as extreme statistical outliers in the top-25 list, although C9290 shows a large claim count (7.7K claims) with low average payment ($1 avg paid/claim) and $7.7K revenue, which is a notable pattern of high frequency but low per-claim reimbursement within the provider's reported mix.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	80	$6,470	$537.3K
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…	500	$780	$391K
27130	In this procedure, the provider surgically replaces the hip joint by prosthesis, or artificial hip joint. He replaces both the femoral and acetabular components with or without using an autograft or…	20	$6,860	$137.1K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	90	$330	$30K
66982	The provider inserts an intraocular lens prosthesis after extracapsular cataract extraction using complex techniques and devices. He may perform this by means of an iris expansion device, providing…	40	$780	$28.2K
64721	Neuroplasty or transposition of the median nerve at the carpal tunnel is done to treat a condition called carpal tunnel syndrome (CTS). The carpal tunnel is a narrow tunnel in the wrist through which…	40	$600	$22.8K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	60	$390	$22.7K
29881	The provider examines the inside of the knee joint with an arthroscope. She repairs the joint by removing the meniscus, a crescent shaped cartilage cushion, from either the medial or lateral…	20	$960	$21.1K
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.	70	$240	$16.4K
29880	In this procedure, the provider performs arthroscopic examination of the knee joint. She removes the damaged and torn meniscus from the medial and lateral compartments of the knee joint along with…	10	$1,020	$13.2K

Showing 1–10 of 16

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. West Virginia Distribution

Tri-state Surgical Center, LLC — 1 of 16 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. state median

16 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
66984	33	90	210	$70	$60.7K
27447	4	70	30	$1,070	$38.6K
27130	25	50	20	$940	$23.6K
29881	3	10	20	$750	$18.8K
66982	13	30	30	$400	$17.9K
C9290	2	10	12,640	$1	$13.8K
64721	5	10	30	$360	$11.2K
45385	24	70	40	$200	$10.4K
29880	3	10	20	$520	$9.3K
29824	1	10	10	$640	$7.7K

Showing 1–10 of 16

Related Providers

Other providers that share a Tax Identification Number (TIN) with Tri-state Surgical Center, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rehan Waheed	VA	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$181.7K	$0
Noel Ashcraft	VA	Interventional Pain Medicine Physician	$160.2K	$0
Troy Foster	WV	Orthopaedic Surgery Physician	$87K	$0
Lindsey Evers	WV	Certified Registered Nurse Anesthetist	$62.5K	$0
Duong Ly	WV	Anesthesiology Physician	$56K	$0
Thomas Downey	WV	Certified Registered Nurse Anesthetist	$28.5K	$0
Debra Clise	DC	Certified Registered Nurse Anesthetist	$15.6K	$0

Nearby Providers

Other providers in the same ZIP code as Tri-state Surgical Center, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Shenandoah Valley Medical System, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$61M
City Hospital, Inc	WV	General Acute Care Hospital	$0	$41.1M
Eastern Panhandle Mental Health Center (waiver)	WV	Community/Behavioral Health Agency	$0	$28.8M
Stepping Stones Cottages, LLC	WV	Counseling Psychologist	$0	$26.6M
University Healthcare Physicians, Inc.	WV	Family Medicine Physician	$0	$17.5M
American Family Matters LLC	WV	Community/Behavioral Health Agency	$0	$16.9M
Berkeley County Emergency Ambulance Authority	WV	Land Ambulance	$864.6K	$5.6M
Eastern Panhandle Mental Health (rehab)	WV	Community/Behavioral Health Agency	$0	$5.7M
City Of Martinsburg	WV	Land Ambulance	$222.2K	$2.7M
Lance Pittman	WV	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$2.3M

Tri-state Surgical Center, LLC — Billing Profile & Reimbursement Data

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Tri-state Surgical Center, LLC — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References