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 1275086431)

Field	Value
Entity Type	Organization
Organization	Prisma Health-upstate
Address	1025 Verdae Blvd
City	Greenville
State	SC
ZIP	29607
Taxonomy	Sleep Disorder Diagnostic Clinic/Center
NPI Enumerated	July 25, 2016

Payer Source	Total Paid
Medicaid	$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.

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	4,200	$470	$2M
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.	2,690	$740	$2M
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	1,790	$420	$747.9K
95806	A technologist is not in attendance during this sleep study, which involves measuring several parameters while the patient sleeps in a clinic or sleep lab to help diagnose sleep disorders.	1,370	$200	$271.8K

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 — 4 of 4 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

4 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	1	20	380	$520	$421.9K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	1	40	120	$330	$201.6K
95811	During the study, the physician monitors the sleep pattern of the patient, along with different bodily functions during the sleep cycle extending over a period of six hours or more.	1	20	30	$320	$65.7K
95806	A technologist is not in attendance during this sleep study, which involves measuring several parameters while the patient sleeps in a clinic or sleep lab to help diagnose sleep disorders.	1	10	100	$160	$34.7K

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
Greenville County Disabilities And Special Needs Board	SC	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$51.7M
Heart Of The Carolinas Medical Supply, LLC	SC	Nursing Care Agency	$0	$36.4M
Caris Healthcare LLC	SC	Community Based Hospice Care Agency	$0	$36.3M
Greenville County Commission On Alcohol And Drug Abuse	SC	Substance Use Disorder Rehabilitation Clinic/Center	$0	$12.7M
St. Francis Hospital Inc	SC	General Acute Care Hospital	$0	$9M
Tribe513, P.A.	SC	Pediatric Adolescent Medicine Physician	$0	$8.6M
Luxor Scientific, LLC	SC	Clinical Medical Laboratory	$2.2M	$5.6M
Pleasantburg Drive Dental Health Center, P.C.	SC	General Practice Dentistry	$0	$6.5M
Inspirium Ihc Upstate, LLC	SC	Home Health Agency	$0	$6.4M
Bon Secours Ambulatory Services - St. Francis, LLC	SC	Urgent Care Clinic/Center	$0	$6.4M

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