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 1154432458)

Field	Value
Entity Type	Organization
Organization	Prisma Health-midlands
Address	Five Richland Medical Park
City	Coulmbia
State	SC
ZIP	29203
Taxonomy	General Acute Care Hospital
NPI Enumerated	August 31, 2006

Payer Source	Total Paid
Medicaid	$7.4M
Medicare	$0

Medicaid: Complete Services Breakdown

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

157 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.	28,310	$80	$2.1M
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.	23,890	$70	$1.6M
80081	The lab analyst performs an obstetric panel; this panel must include tests for a complete blood count with differential, a hepatitis B surface antigen test, a single–result test for HIV–1 antigens…	2,970	$170	$495.5K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	11,110	$40	$399.9K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	4,170	$80	$325.6K
86850	The lab analyst performs a screening test using patient blood to determine the presence of any antibodies to red blood cells, called RBCs, other than the A and B antigens.	1,270	$210	$262.5K
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…	5,840	$40	$245.3K
82306	The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced…	11,220	$20	$224.5K
87480	The lab analyst performs a test for Candida species using direct nucleic acid probe technique.	2,980	$80	$223.6K
86780	The lab analyst performs an immunoassay to evaluate the patient’s serum for antibodies to Treponema pallidum, a spiral shaped bacteria called a spirochete, that causes syphilis.	4,950	$40	$188.2K

Showing 1–10 of 157

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 — 7 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

157 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.	30	210	1,470	$60	$615K
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…	49	150	2,500	$50	$324.9K
C9803	Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source	41	50	510	$110	$290.3K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	42	90	730	$60	$275.7K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	25	710	350	$60	$247.2K
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…	77	130	780	$60	$178.3K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	13	120	1,100	$30	$170.4K
81001	Urinalysis is used to detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is used to detect urinary tract infections (UTI) and other…	70	180	1,360	$20	$152.1K
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.…	14	80	840	$60	$150.7K
86850	The lab analyst performs a screening test using patient blood to determine the presence of any antibodies to red blood cells, called RBCs, other than the A and B antigens.	31	70	830	$50	$143.6K

Showing 1–10 of 157

Related Providers

Other providers that share a Tax Identification Number (TIN) with Prisma Health-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
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$74.6M
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	$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

Nearby Providers

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

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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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References