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-upstate (NPI 1033664909)

Prisma Health-upstate is a general acute care hospital provider located in Greenville, South Carolina. This profile covers 0 Medicare and 19 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	Prisma Health-upstate
Address	200 Patewood Dr
City	Greenville
State	SC
ZIP	29615
Taxonomy	General Acute Care Hospital
NPI Enumerated	August 22, 2016

Payer Source	Total Paid
Medicaid	$2.4M
Medicare	$0

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
93922	Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral	2,110	$330	$697K
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…	1,560	$380	$588.9K
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…	6,780	$50	$359.6K
93970	The provider performs an ultrasound scanning procedure called a duplex scan to characterize the pattern and direction of blood flow in extremity veins (arms or legs). This is a complete, bilateral…	740	$350	$258.3K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	280	$620	$169.9K
93880	Duplex scanning of arteries for the evaluation of blood flow is a type of non–invasive vascular diagnostic process. A physician can visualize and selectively assess the flow patterns of peripheral…	580	$280	$163.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	140	$330	$46K
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…	710	$50	$36.9K
82565	The lab analyst measures the amount of creatinine in a patient specimen, typically of blood. Creatinine is the waste material generated by the muscle tissue produced from the breakdown of creatine…	120	$290	$34.2K
93925	The provider performs a duplex ultrasound scan of the lower extremity arteries or bypass grafts on both sides. Providers perform noninvasive arterial diagnostic procedures to examine the rate of…	1,530	$10	$18.4K

Showing 1–10 of 19

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-upstate — 2 of 16 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

19 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
Q9967	Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	67	110	1,880	$100	$414K
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…	302	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	444	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…	1,017	2,480	350	$80	$246K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	34	60	350	$190	$230.8K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	58	70	320	$40	$159.1K
87070	The lab analyst performs the technical lab steps to culture a specimen from any source except urine, blood, or stool. This service involves aerobic culture, which refers to the presence of oxygen.…	76	80	840	$60	$150.7K
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,…	259	610	190	$50	$98.4K
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…	12	90	260	$100	$58.4K
93922	Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral	2	50	120	$140	$53.6K

Showing 1–10 of 19

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Childrens Medical Center	SC	Specialist	$0	$17.1M
Agapi Behavioral Consultants	SC	Behavior Analyst	$0	$15M
St Francis Hospital, Inc.	SC	General Acute Care Hospital	$0	$13M
Eastside Pediatric Dentistry PA	SC	Pediatric Dentistry	$0	$10M
Magnolia Medical Group Inc	SC	Physical Therapist	$0	$9.9M
Greenville Health Corporation	SC	Durable Medical Equipment & Medical Supplies	$0	$8.9M
D&s Community Services Sc, LLC	SC	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$8.3M
Bloom Behavioral Therapy LLC	SC	Mental Health Counselor	$0	$7.5M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$6.4M
Clemson Eye, PA	SC	Ophthalmology Physician	$0	$5.5M

Prisma Health-upstate — Billing Profile & Reimbursement Data

Sign up for Prisma Health-upstate — Billing Profile & Reimbursement Data policy alerts

Prisma Health-upstate — Billing Profile & Reimbursement Data

Sign up for Prisma Health-upstate — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health University Medical Group	SC	Family Medicine Physician	$0	$171.7M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$86.9M
Prisma Health Medical Group-midlands	SC	Multi-Specialty Clinic/Center	$0	$77.6M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$25M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$22M
Prisma Health-upstate	SC	Developmental Disabilities Clinic/Center	$0	$19.7M
Prisma Health University Medical Group	SC	Developmental - Behavioral Pediatrics Physician	$0	$16M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$15.6M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$13.1M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$10.9M