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 1326043548)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prisma Health-midlands
Address	129 N. Washington Street
City	Sumter
State	SC
ZIP	29150
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 15, 2005

Payer Source	Total Paid
Medicaid	$28.1M
Medicare	$0

This provider is effectively a single‑payer Medicaid operator: there is no Medicare billing on file and total Medicaid revenue is $28.1M, indicating Medicaid is the sole reported federal payer driving lifetime revenue for this entity. Analysts should treat any Medicare comparisons as inapplicable for this profile and focus competitive analysis on Medicaid activity.

Revenue is moderately concentrated: the top three Medicaid codes account for 32.8% of this provider's total Medicaid revenue, led by 11042 (8.7K claims, $362 avg paid/claim, $3.2M revenue, 15.1%), followed by 99283 (54.2K claims, $37 avg paid/claim, $2M revenue, 9.6%) and 81001 (32.8K claims, $52 avg paid/claim, $1.7M revenue, 8.2%). This concentration shows that a relatively small set of services—wound debridement, emergency department evaluation, and urinalysis—drive roughly one third of Medicaid receipts.

The code mix indicates a hospital‑centric, high‑throughput emergency and ancillary testing operation: dominant codes include surgical debridement 11042, multiple ED E/M codes such as 99283 and 99282, high‑volume lab panels 80053 and 80048, and frequent parenteral therapeutic injections (96372, 96365). Together these codes point to an acute care facility that handles large ED volumes, significant wound care/surgical procedures, and substantial outpatient diagnostics and infusion services.

PRISMA HEALTH‑MIDLANDS is a local leader for certain specialty services in state Medicaid: 11042 ranks #1 of 57 providers in‑state (100th percentile; extreme outlier), signaling unusually high state volume for surgical debridement and wound care. Emergency and lab services are also above typical in‑state volumes—99283 ranks #12 of 341 (97th percentile; notably above typical), 81001 ranks #8 of 180 (96th percentile; notably above typical)—supporting a competitive position as a major regional ED and diagnostics provider.

There are specific outlier signals beyond debridement: 96372 (therapeutic/prophylactic injection) shows 21.8K claims and $1.1M revenue and is described as an extreme outlier, ranking #13 of 409 providers in‑state (97th percentile). This atypically high utilization of injectable therapeutics suggests substantial procedural throughput in outpatient or ED settings that should be investigated further for operational drivers.

The emergency department footprint is large and weighted toward low‑to‑moderate complexity visits: 99283 reports 54.2K claims ($2M revenue), 99284 reports 35.5K claims ($390.5K revenue), and 99282 reports 11.5K claims ($1M revenue). The combination of these claim volumes and the presence of many related infusion and lab codes implies high ED visit volumes with frequent ancillary services billed per visit.

Ancillary outpatient testing and therapy services are material revenue contributors and reinforce the acute‑care profile: high volumes for comprehensive and basic metabolic panels (80053: 39.5K claims, $1.4M; 80048: 22.4K claims, $649.3K), urinalysis (81001: 32.8K claims, $1.7M), pregnancy testing (81025: 16.9K claims, $828.3K), and therapeutic exercise/physical therapy codes (97110: 30.6K claims, $950.1K; 97530: 12.1K claims, $411K). These patterns suggest substantial outpatient diagnostic throughput co‑located with clinical care.

The provider has long tenure in the NPI registry (NPI enumerated 2005-06-15 (~21 years ago)), indicating an established presence in the state Medicaid network; combined with the concentration and high rank positions on multiple codes, this tenure supports a sustained operational role rather than a recent or transient billing pattern.

Medicaid: Complete Services Breakdown

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

352 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	8,710	$360	$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.	54,160	$40	$2M
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…	32,830	$50	$1.7M
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.	39,530	$40	$1.4M
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…	21,770	$50	$1.1M
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.	11,450	$90	$1M
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…	30,650	$30	$950.1K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	13,830	$70	$940.7K
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…	17,880	$50	$893.8K
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.	16,900	$50	$828.3K

Showing 1–10 of 352

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 — 10 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

352 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	52	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.	17	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.	68	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.	12	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.	18	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.	15	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…	22	60	170	$430	$434.9K
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.	14	140	2,520	$90	$415.3K
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…	15	290	2,600	$60	$414.4K
Q9967	Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	21	110	1,880	$100	$414K

Showing 1–10 of 352

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sumter Pediatrics, P.A.	SC	Pediatrics Physician	$0	$24.4M
Tandem Health Sc	SC	Federally Qualified Health Center (FQHC)	$0	$17.3M
Colonial Family Practice, LLC	SC	Family Medicine Physician	$0	$9.5M
Tandem Health Sc	SC	Federally Qualified Health Center (FQHC)	$0	$7.8M
Wesmark Dental Health Center	SC	General Practice Dentistry	$0	$6.3M
Addus Healthcare (south Carolina), Inc.	SC	In Home Supportive Care Agency	$0	$5.5M
Carolina Children's Dentistry, LLC	SC	Pediatric Dentistry	$0	$5.2M
Sumter School District	SC	Local Education Agency (LEA)	$0	$4.2M
Kool Smiles, PC	SC	General Practice Dentistry	$0	$4.2M
Sumter County Ems	SC	Ambulance	$971.3K	$3M

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	$74.6M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$68.3M
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