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 Medical Group-midlands (NPI 1275988321)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prisma Health Medical Group-midlands
Address	3555 Harden Street Ext Ste 300
City	Columbia
State	SC
ZIP	29203
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	April 26, 2016

Payer Source	Total Paid
Medicaid	$77.6M
Medicare	$0

PRISMA HEALTH MEDICAL GROUP-MIDLANDS is effectively a single-payer Medicaid outpatient and acute-care provider in the available data: there is no Medicare billing on file while lifetime Medicaid revenue is $77.6M, indicating Medicaid accounts for the entirety of observed federal program revenue for this entity. The NPI was enumerated on 2016-04-26 (~10 years ago), so the practice has been operating under this identifier for about a decade, giving sufficient tenure for established referral and service patterns to develop.

Revenue concentration is heavily skewed toward a small set of outpatient E/M services and one high-cost immunoglobulin code: the top 3 Medicaid codes by revenue account for 47.1% of this provider’s total Medicaid revenue. Specifically, 99214 and 99213 together contribute a combined large share (99214: $14.2M, 22.0%; 99213: $9.6M, 14.8%) and 90378 contributes $6.7M (10.3%), showing reliance on office E/M visits plus a single high-dollar drug/procedure for a large slice of revenue.

The code mix suggests this organization operates as a high-volume multi-specialty ambulatory network with substantial emergency and inpatient follow-up activity. Large volumes of established-patient office visits (99214, 99213) and moderate-to-high level ED visits (99284, 99285) paired with significant counts of inpatient subsequent care codes (99232, 99231, 99222) and consultation codes (99244, 99243) indicate integrated ambulatory, ED, and inpatient services rather than a narrow specialty clinic.

PRISMA is a dominant statewide provider for multiple high-volume Medicaid codes: 99214 ranks #3 of 2483 providers in-state (100th percentile, labeled an extreme outlier), 99213 ranks #4 of 2766 (100th percentile, extreme outlier), and 90378 ranks #1 of 6 providers in-state (100th percentile). Numerous other codes (e.g., 99232, 99215, 93306, 76816) also sit at or near top state percentiles, which together characterize the provider as a major player in South Carolina for both general evaluation/management services and several procedural lines.

Several codes are explicitly flagged as extreme outliers or notably above typical state volumes, signaling unusual scale rather than specialty rarity: 99214, 99213, 99232, 99215, 99204, and others are called extreme outliers (100th–99th percentiles) and 90378 is the highest-volume biller for that code in-state. These labels indicate the provider’s billing volumes for these services are far above typical peers in South Carolina, consistent with system-level throughput.

The presence of high-revenue procedure and diagnostic services beyond E/M—such as 93306 echocardiography ($1.9M, ranks #4 of 143, 98th percentile), 76816 fetal reexamination ultrasound ($1.7M, ranks #3 of 103, 98th percentile), and EEG/long-EEG services (95816 and 95720 at $1.1M and $509.2K respectively, each ranked #1 in-state)—points to substantial specialty diagnostic capabilities (cardiology, maternal-fetal medicine, neurology) co-located or affiliated with the group. This mix supports a multi-specialty clinic/center operational profile.

Operationally, heavy reliance on high-volume E/M codes (99214, 99213) combined with significant ED (99284, 99285) and inpatient follow-up (99232, 99231) suggests throughput and capacity are key competitive levers: the provider likely derives predictable per-visit revenue from ambulatory care while also capturing downstream urgent and inpatient care. That concentration implies sensitivity to changes in Medicaid policy or reimbursement around high-volume E/M codes and the high-cost immunoglobulin represented by 90378.

Given the absence of Medicare billing, payer mix is lopsided toward Medicaid, making the provider’s financial exposure and competitive position especially tied to South Carolina Medicaid policies and managed care contracts. Analysts should treat this profile as a Medicaid-dominant operation where market share, utilization management, and state-level coverage rules will materially affect revenue and utilization trends.

Medicaid: Complete Services Breakdown

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

224 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	203,120	$70	$14.2M
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…	199,160	$50	$9.6M
90378	Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial…	2,240	$2,970	$6.7M
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.	64,710	$90	$5.6M
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.	26,800	$120	$3.2M
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.	58,450	$50	$2.9M
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	18,070	$150	$2.7M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	54,130	$50	$2.7M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	19,390	$110	$2.1M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	15,780	$120	$1.9M

Showing 1–10 of 224

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 Medical Group-midlands — 22 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

224 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1024	Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter	9	10	980	$570	$1.8M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	2	10	150	$410	$1.4M
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	13	10	510	$180	$1.3M
90378	Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial…	1	10	340	$1,490	$1.1M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	166	210	320	$130	$707.4K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	34	90	260	$430	$688.8K
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.	10	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.	8	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.	13	200	1,680	$50	$443.2K
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.	4	20	380	$520	$421.9K

Showing 1–10 of 224

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health University Medical Group	SC	Family Medicine Physician	$0	$171.7M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$74.6M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$68.3M
Centra Medical Group, LLC	VA	Family Medicine Physician	$0	$60.1M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$28.1M
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-midlands	SC	General Acute Care Hospital	$0	$11.8M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$10.9M
Prisma Health Medical Group-midlands	SC	Orthopaedic Surgery Physician	$0	$8.7M

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-midlands	SC	General Acute Care Hospital	$0	$7.4M
Prisma Health-midlands	SC	Emergency Medicine Physician	$0	$6.8M
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

Prisma Health Medical Group-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