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

Why is the Medicaid comparison limited to Maryland 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. Maryland (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 1366491201)

Field	Value
Entity Type	Organization
Organization	Tri-state Community Health Center, Inc
Address	130 W High St
City	Hancock
State	MD
ZIP	21750
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	May 9, 2006

Payer Source	Total Paid
Medicaid	$5.8M
Medicare	$0

Medicaid: Complete Services Breakdown

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

32 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	22,830	$110	$2.6M
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…	16,720	$120	$2M
T1015	Clinic visit/encounter, all-inclusive	15,940	$40	$605.7K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	2,170	$130	$286.3K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	810	$140	$111.9K
59430	For this service, the provider or nonphysician healthcare professional provides care to the patient in the outpatient setting following the delivery. Routine postpartum care can involve one or more…	780	$130	$103.9K
99396	The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64.	620	$140	$85.1K
99204	The provider sees a new 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 provider…	120	$120	$14K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	1,530	$10	$7.6K
99385	The provider performs a well–patient visit for a patient who is between the ages of 18 and 39.	60	$130	$7K

Showing 1–10 of 32

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maryland Distribution

Tri-state Community Health Center, Inc — 3 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maryland

Full comparison — all codes billed, vs. Maryland median

32 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	13	60	380	$170	$4.1M
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…	110	3,670	680	$90	$310K
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…	97	3,280	610	$80	$296.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	295	320	290	$120	$128K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	27	40	100	$30	$119.8K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	240	1,000	200	$120	$96.3K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	43	90	250	$30	$91.2K
99204	The provider sees a new 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 provider…	461	930	110	$100	$90.1K
99203	The provider sees a new 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 provider…	566	730	110	$70	$81.9K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	14	290	140	$120	$62.8K

Showing 1–10 of 32

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tri-state Community Health Center, Inc	WV	Federally Qualified Health Center (FQHC)	$0	$1.7M
Raymond Banfer	MD	Family Medicine Physician	$10.5K	$72.9K

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

Related Providers

Frequently Asked Questions

References