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-midlands (NPI 1154373843)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prisma Health-midlands
Address	5 Richland Medical Park Dr
City	Columbia
State	SC
ZIP	29203
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 17, 2006

Payer Source	Total Paid
Medicaid	$74.6M
Medicare	$0

This provider is effectively single-payer in the Medicare/Medicaid mix: there is no Medicare billing on file, while Total Medicaid revenue is $74.6M, indicating material reliance on Medicaid as the primary public payer for its services. The absence of Medicare activity should be considered when benchmarking against mixed-payer peers.

Revenue is moderately concentrated: the Top 3 Medicaid codes by revenue account for 29.9% of this provider's total Medicaid revenue. Those top three codes are 36415 ($7.4M, 14.2%), 97110 ($4.3M, 8.3%), and 81025 ($3.9M, 7.4%), signaling that a small set of high-volume lab and therapy codes drive a large share of Medicaid dollars.

The code mix points to a hospital with high-volume outpatient diagnostics, emergency care, and ancillary services: large claim counts and revenue for lab codes (36415, 81025, 80048, 80053, 81003), imaging (70553, 70551, 93306), and ED E/M codes (99283, 99284, 99282) indicate substantial ED throughput together with in-house laboratory and imaging capacity. These patterns are consistent with a general acute care hospital operating extensive outpatient and emergency service lines.

97110 is an extreme statewide outlier and appears to be a strategic service line for this provider: it ranks #4 of 285 providers in-state at the 99th percentile with 61K claims and $4.3M in revenue. That position suggests a dominant physical/rehabilitation therapy footprint relative to in-state peers and a likely emphasis on therapy services in outpatient workflows.

Emergency and clinic evaluation-and-management activity is a major revenue generator in Medicaid: 99283 has 50.1K claims and $3.8M revenue (7.2%, rank #17 of 341, 95th percentile), while G0463 shows 28.8K claims and $1.7M (3.3%, rank #4 of 65, 95th percentile). These volumes reinforce that both ED visits and hospital outpatient clinic encounters are key operational drivers.

Infusion and injection services contribute meaningfully to Medicaid revenue and reflect active acute and outpatient treatment delivery: 96374 ($2.9M, 5.5%), 96372 ($1.9M, 3.7%), 96361 ($1.7M, 3.2%), and 96365 ($943.2K, 1.8%) together point to substantial IV/therapeutic procedure throughput across ED and outpatient settings. Several of these codes sit at or above typical state volumes, supporting a consistent role for medication administration services.

Laboratory and specimen-collection services are both high-volume and comparatively strong versus in-state peers: 36415 ranks #16 of 713 (98th percentile) with $7.4M in revenue, C9803 (SARS‑CoV‑2 specimen collection) ranks #5 of 46 (91st percentile) with $1.4M, and other lab panels/test codes appear at high state percentiles. This indicates a robust lab testing and specimen-collection capability that feeds a broad outpatient and ED patient base.

The provider has an established operational history that supports these volumes: the NPI was enumerated on 2006-05-17 (~20 years ago). State-level rank and percentile evidence shows it is a strong, high-volume Medicaid participant for many codes (for example, 97110 at the 99th percentile and 99212 at the 99th percentile), though several specialty services (imaging and pathology) place in mid-to-high percentiles rather than at the very top, suggesting breadth of services rather than single-service dominance.

Medicaid: Complete Services Breakdown

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

486 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.	39,840	$190	$7.4M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	61,030	$70	$4.3M
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.	16,080	$240	$3.9M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	50,120	$80	$3.8M
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…	25,480	$120	$3.2M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	10,350	$280	$2.9M
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.	29,760	$90	$2.6M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	13,930	$150	$2.1M
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…	1,780	$1,190	$2.1M
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	12,900	$150	$1.9M

Showing 1–10 of 486

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-midlands — 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

486 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S9445	Patient education, not otherwise classified, non-physician provider, individual, per session	13	10	7,820	$50	$721.4K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	92	340	2,970	$80	$711.1K
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.	25	210	1,470	$60	$615K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	72	350	2,590	$70	$550.2K
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	17	340	110	$40	$450.5K
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	43	350	100	$50	$446.9K
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	32	200	1,680	$50	$443.2K
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…	11	60	170	$430	$434.9K
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	8	20	380	$520	$421.9K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	9	140	2,520	$90	$415.3K

Showing 1–10 of 486

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Carolina Department Of Mental Health Accounting Office	SC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$36M
Carolina Pediatrics & Adolescent Care, PA	SC	Pediatrics Physician	$0	$12.3M
Sc House Calls Inc	SC	Family Medicine Physician	$0	$11.6M
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
Lexington Richland Alcohol & Drug Abuse Council, Inc.	SC	Substance Use Disorder Rehabilitation Clinic/Center	$0	$5.3M
Medical University Hospital Authority	SC	General Acute Care Hospital	$0	$4.6M
Carolina Allergy & Asthma Consultants	SC	Allergy & Immunology Physician	$0	$3.2M
Robert Collins	SC	Internal Medicine Physician	$2.7M	$0
Joel Waldrop	SC	Emergency Medicine Physician	$2.4M	$9.3K

Prisma Health-midlands — Billing Profile & Reimbursement Data

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Key Findings

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 Medical Group-midlands	SC	Multi-Specialty Clinic/Center	$0	$77.6M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$68.3M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$28.1M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$11.8M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$7.4M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$6.9M
Prisma Health Tuomey	SC	Emergency Medicine Physician	$0	$6.8M
Prisma Health-midlands	SC	Emergency Medicine Physician	$0	$6.8M
Prisma Health-midlands	SC	Home Health Agency	$0	$4.6M