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.

Lexington Health Inc (NPI 1386241834)

Field	Value
Entity Type	Organization
Organization	Lexington Health Inc
Address	2720 Sunset Blvd
City	West Columbia
State	SC
ZIP	29169
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 7, 2020

Payer Source	Total Paid
Medicaid	$27.4M
Medicare	$0

Key Findings

LEXINGTON HEALTH INC is effectively a single‑payer Medicaid provider: there is no Medicare billing on file and all recorded lifetime federal revenue is from Medicaid totaling $27.4M. This concentration means analyses of this entity’s financial footprint should treat Medicaid as the sole federal payer driver of observed volumes and revenues. NPI enumeration date is 2020-10-07 (~6 years ago), indicating this billing profile developed in a relatively recent operational window.

Revenue is highly concentrated in a small set of procedures: the precomputed top three Medicaid codes account for 53.8% of the provider’s total Medicaid revenue. Those top drivers include 36415 ($6.8M, 33.0% of Medicaid revenue), J7030 ($2.5M, 12.0%), and 80053 ($1.8M, 8.7%), which together dominate the facility’s Medicaid receipts and should be the focus for any revenue risk or service‑line analysis.

The code mix indicates a lab‑and‑infusion‑centric operation with substantial specimen collection and diagnostic testing upstream of care: 36415 (venous blood draw), 80053 (comprehensive metabolic panel), and many other high‑volume lab codes such as 87077, 87081, 87086, 80061, 81001, and 87491 appear prominently. Combined with high utilization of infusion solution codes (J7030, J7050, J7040), the profile is consistent with a hospital that processes large outpatient/inpatient lab volumes and delivers routine IV fluid/infusion services at scale.

LEXINGTON is a statewide outlier on several laboratory and diagnostic procedures. For example, 36415 ranks #6 of 713 providers in the state (99th percentile) and is labeled an extreme outlier, and 80053 ranks #7 of 212 (97th percentile, notably above typical state volume). Additional extreme or top‑rank observations include 87081 (rank #1 of 87, 100th percentile) and 86703 (rank #1 of 14, 100th percentile), signaling unusually high state market share for specific lab testing.

While several lab and radiology/diagnostic codes show dominance, emergency department activity appears substantial but not uniquely dominant statewide. ED E/M codes 99283 (22.7K claims, $955.2K revenue, rank #48 of 341, 86th percentile) and 99284 (25.3K claims, $329K revenue, rank #39 of 353, 89th percentile) indicate meaningful ED throughput that is above typical providers but not at the extreme top of state ED volumes. The mixed percentile pattern suggests the provider is a major regional ED participant but relies more heavily on high‑volume lab services for Medicaid revenue.

Infusion and supply codes further characterize service operations: J7030 shows 13.5K claims and $2.5M revenue (rank #10 of 71, 87th percentile) while J7050 has 11.2K claims and $827.2K revenue (rank #5 of 52, 92th percentile). These data points imply regular, high‑volume saline infusion usage consistent with inpatient/observation services, emergency care, or an infusion unit contributing materially to Medicaid revenue.

Several microbiology and culture codes are markedly above typical state volumes, suggesting robust in‑house microbiology or a referral testing role. Examples include 87077 (15.8K claims, $394K revenue, rank #3 of 87, 98th percentile; described as an extreme outlier) and 87086 (32.1K claims, $385.6K revenue, rank #5 of 108, 96th percentile), indicating the provider processes large numbers of organism identification and quantitative urine culture tests relative to peers. These patterns support the interpretation that lab operations, not procedural specialties, are the organization’s primary Medicaid revenue engine.

Given the NPI was enumerated on 2020-10-07 (~6 years ago) and the current pattern of concentrated, high‑volume lab and infusion billing, the provider appears to have scaled diagnostic and infusion services quickly in a short timeframe. For payer/provider analysts, the combination of single‑payer Medicaid dependency, concentrated top‑code revenue (53.8% in the top three), and multiple codes at or near the top of state rankings flags the lab/diagnostic and infusion service lines as both the main revenue drivers and the primary areas for competitive or operational scrutiny.

Medicaid: Complete Services Breakdown

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

408 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.	66,610	$100	$6.8M
J7030	Infusion, normal saline solution , 1000 cc	13,530	$180	$2.5M
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.	59,970	$30	$1.8M
86900	The lab analyst performs a test to determine the patient’s blood type within the ABO blood group system using serum plasma as the specimen.	8,110	$150	$1.2M
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.	22,740	$40	$955.2K
J7050	Infusion, normal saline solution, 250 cc	11,180	$70	$827.2K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	22,950	$40	$826.3K
86703	The lab analyst performs an immunoassay to evaluate the patient’s specimen, typically serum, for antibodies to HIV 1 or HIV 2. This code applies to a single result for either antibody.	11,770	$60	$694.2K
A9577	Injection, gadobenate dimeglumine (multihance), per ml	600	$710	$425.5K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	9,810	$40	$412K

Showing 1–10 of 408

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

Lexington Health Inc — 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

408 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.	7	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.	142	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.	48	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.	39	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.	30	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…	25	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.	60	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…	91	290	2,600	$60	$414.4K
Q9967	Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	9	110	1,880	$100	$414K
J7030	Infusion, normal saline solution , 1000 cc	10	70	2,620	$60	$337.3K

Showing 1–10 of 408

Related Providers

Other providers that share a Tax Identification Number (TIN) with Lexington Health Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lexington County Health Services District Inc	SC	General Acute Care Hospital	$0	$19.2M
Lexington Health Inc	SC	Urgent Care Clinic/Center	$0	$8.7M
Lexington Health Inc	SC	Pediatric Adolescent Medicine Physician	$0	$5.7M
Lexington Health Inc	SC	Emergency Medicine Physician	$0	$4.2M
Lexington County Health Serv	SC	General Acute Care Hospital	$0	$4M
Steven Madden	SC	Hematology & Oncology Physician	$4M	$0
Lexington Health Inc	SC	Family Medicine Physician	$0	$4M
Lexington Health Inc	SC	Obstetrics & Gynecology Physician	$0	$3.5M
Vijaya Korrapati	SC	Hematology & Oncology Physician	$3.4M	$0
Perrie Ryan	SC	Hematology & Oncology Physician	$3.3M	$0

Nearby Providers

Other providers in the same ZIP code as Lexington Health Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Palmetto Infusion Services LLC	SC	Infusion Therapy Clinic/Center	$0	$93.6M
United Cerebral Palsy Of South Carolina, Inc	SC	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$15.7M
Palmetto Retina Center LLC	SC	Ophthalmology Physician	$0	$10.6M
Karen Park Family Dentistry, P.A.	SC	Dentist	$0	$4.2M
John Payne	SC	Ophthalmology Physician	$4M	$0
John Wells	SC	Ophthalmology Physician	$3.9M	$0
Lexington Treatment Specialists LLC	SC	Methadone Clinic	$76.7K	$3.6M
William Clark	SC	Ophthalmology Physician	$3.3M	$0
Asheesh Lal	SC	Hematology & Oncology Physician	$3.2M	$0
James Wells	SC	Hematology & Oncology Physician	$3.2M	$0

Lexington Health Inc — 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