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 1144775032)

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 20, 2016

Payer Source	Total Paid
Medicaid	$6.4M
Medicare	$0

Medicaid: Complete Services Breakdown

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

151 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	27,870	$80	$2.2M
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	4,410	$110	$493.9K
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	330	$1,450	$480.1K
77066	The provider performs X–ray imaging on both breasts in a patient with a lump or suspected cancer and may use specially designed computer software to help identify or diagnose potential abnormalities…	2,660	$130	$343.5K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	3,050	$100	$310.8K
88300	The physician, typically a pathologist, performs a level I examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	2,250	$120	$265.3K
76770	A retroperitoneal ultrasound is a noninvasive procedure used to assess the body parts within the abdomen (i.e.Kidneys, urinary bladder, and aorta). This particular code is used when the ultrasound is…	1,840	$140	$259.6K
76642	In this procedure, the provider performs a focused ultrasound of one breast on a limited area. The procedure includes documentation of the images.	7,120	$30	$241.9K
73721	In this diagnostic procedure, the provider performs magnetic resonance imaging of a lower extremity joint without using contrast material.	300	$710	$211.8K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	1,280	$160	$197.9K

Showing 1–10 of 151

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 — 8 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

151 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	63	210	1,470	$60	$615K
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	19	60	170	$430	$434.9K
Q9967	Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	66	110	1,880	$100	$414K
D2930	N/A	128	130	1,060	$150	$371.1K
J7030	Infusion, normal saline solution , 1000 cc	65	70	2,620	$60	$337.3K
80048	The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood…	96	150	2,500	$50	$324.9K
A9585	Injection, gadobutrol, 0.1 ml	6	40	380	$300	$271.7K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	28	710	350	$60	$247.2K
70551	The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam.	30	50	90	$220	$222.7K
J7120	Ringers lactate infusion, up to 1000 cc	6	70	1,700	$40	$198.5K

Showing 1–10 of 151

Related Providers

Other providers that share a Tax Identification Number (TIN) with Prisma Health-upstate, 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-upstate	SC	General Acute Care Hospital	$0	$86.9M
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-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
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$10.7M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$9.3M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Childrens Medical Center	SC	Specialist	$0	$17.1M
Prisma Health University Medical Group	SC	Developmental - Behavioral Pediatrics Physician	$0	$16M
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
Clemson Eye, PA	SC	Ophthalmology Physician	$0	$5.5M

Prisma Health-upstate — Billing Profile & Reimbursement Data

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Prisma Health-upstate — 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