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

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

Prisma Health Medical Group-midlands (NPI 1003307166)

Field	Value
Entity Type	Organization
Organization	Prisma Health Medical Group-midlands
Address	300 Palmetto Health Pkwy Ste 400
City	Columbia
State	SC
ZIP	29212
Taxonomy	Interventional Cardiology Physician
NPI Enumerated	May 24, 2018

Payer Source	Total Paid
Medicaid	$2.5M
Medicare	$0

Medicaid: Complete Services Breakdown

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

35 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	25,450	$40	$1M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	9,840	$40	$423K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	49,350	$10	$246.7K
0001A	N/A	4,110	$40	$164.4K
0002A	N/A	3,840	$40	$157.5K
93000	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	22,180	$10	$133.1K
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…	670	$60	$40.8K
93297	The provider, who is a physician or other qualified healthcare professional, evaluates the physiologic data from the implantable physiologic cardiovascular monitoring system during a period of up 30…	2,950	$10	$35.4K
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…	1,240	$30	$34.8K
93971	The provider performs an ultrasound scanning procedure called a duplex scan to characterize the pattern and direction of blood flow in extremity veins (arm or leg). This is a unilateral or limited…	2,070	$10	$29K

Showing 1–10 of 35

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Carolina Distribution

Prisma Health Medical Group-midlands — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. South Carolina median

35 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	785	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	428	710	350	$60	$247.2K
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…	46	2,480	350	$80	$246K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	59	110	70	$150	$157.3K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	7	140	690	$80	$153.6K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	110	120	220	$60	$86.2K
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…	65	360	100	$100	$76.9K
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	56	60	130	$170	$67.7K
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…	157	490	90	$100	$63.6K
93971	The provider performs an ultrasound scanning procedure called a duplex scan to characterize the pattern and direction of blood flow in extremity veins (arm or leg). This is a unilateral or limited…	5	90	260	$100	$58.4K

Showing 1–10 of 35

Related Providers

Other providers that share a Tax Identification Number (TIN) with Prisma Health Medical Group-midlands, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health University Medical Group	SC	Family Medicine Physician	$0	$171.7M
Prisma Health Medical Group-midlands	SC	Multi-Specialty Clinic/Center	$0	$77.6M
Centra Medical Group, LLC	VA	Family Medicine Physician	$0	$60.1M
Prisma Health Medical Group-midlands	SC	Orthopaedic Surgery Physician	$0	$8.7M
Prisma Health Medical Group-midlands	SC	Developmental - Behavioral Pediatrics Physician	$0	$5.9M
Prisma Health Medical Group-midlands	SC	Family Medicine Physician	$0	$3.6M
Andrew Mcgown	SC	Sports Medicine (Family Medicine) Physician	$758K	$0
Charles Agunobi	GA	Internal Medicine Physician	$741.1K	$0
Walter Mazzei	SC	Clinical Cardiac Electrophysiology Physician	$480.8K	$0
Anthony Zamcho	SC	Hospitalist Physician	$412.9K	$0

Nearby Providers

Other providers in the same ZIP code as Prisma Health Medical Group-midlands, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Options, Inc.	SC	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$40.2M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$4.3M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$3.1M
School District 5 Of Lexington & Richland Counties	SC	Local Education Agency (LEA)	$0	$2.8M
Kalpesh Purohit	SC	Family Medicine Physician	$2.1M	$0
Irmo Kids Dental LLC	SC	Dental Clinic/Center	$0	$1.8M
Play 2 Learn Early Intervention	SC	Early Intervention Provider Agency	$0	$1.7M
Counseling For Hope & Healing	SC	Professional Counselor	$0	$1.6M
Lexington Health Inc	SC	Ambulatory Surgical Clinic/Center	$792.7K	$22.3K
Lexington Health Inc	SC	Radiology Clinic/Center	$599.2K	$34.3K

Prisma Health Medical Group-midlands — Billing Profile & Reimbursement Data

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Prisma Health Medical Group-midlands — 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

Nearby Providers

Frequently Asked Questions

References