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 Illinois for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Illinois 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. Illinois (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.

Prism Health Care Services, Inc. (NPI 1457314130)

Field	Value
Entity Type	Organization
Organization	Prism Health Care Services, Inc.
Address	1337 Basswood Road
City	Schaumburg
State	IL
ZIP	60173
Taxonomy	Durable Medical Equipment & Medical Supplies
NPI Enumerated	April 11, 2006

Payer Source	Total Paid
Medicaid	$4.9M
Medicare	$0

Medicaid: Complete Services Breakdown

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

60 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
E0601	Continuous positive airway pressure (CPAP) device	19,230	$50	$884.8K
E0562	Humidifier, heated, used with positive airway pressure device	21,450	$20	$343.2K
E1390	Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate	3,850	$80	$323.7K
E0470	Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive…	2,400	$130	$309.3K
A7030	Full face mask used with positive airway pressure device, each	4,980	$60	$274K
E0260	Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress	5,800	$50	$261K
K0001	Standard wheelchair	8,130	$30	$219.5K
A7034	Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap	5,160	$40	$190.9K
A4604	Tubing with integrated heating element for use with positive airway pressure device	9,030	$20	$171.5K
K0003	Lightweight wheelchair	3,320	$50	$162.5K

Showing 1–10 of 60

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.

Claims Volume vs. Illinois Distribution

Prism Health Care Services, Inc. — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Illinois

Full comparison — all codes billed, vs. Illinois median

60 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	22	30	2,590	$110	$1.4M
T4541	Incontinence product, disposable underpad, large, each	120	130	2,190	$50	$644.7K
B4154	Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or…	17	20	640	$130	$556.1K
E1390	Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate	67	200	1,950	$90	$492K
B4152	Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include…	23	30	1,310	$110	$298K
B4150	Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100…	22	30	1,020	$80	$291.3K
E0601	Continuous positive airway pressure (CPAP) device	6	140	2,000	$50	$209.5K
A4629	Tracheostomy care kit for established tracheostomy	9	10	200	$90	$191.4K
E0973	Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each	10	20	850	$100	$147.2K
E2611	General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware	2	10	730	$100	$132.9K

Showing 1–10 of 60

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Quest Diagnostics LLC Il	IL	Clinical Medical Laboratory	$3.5M	$50.7M
Alpha Lab Services Inc	IL	Clinical Medical Laboratory	$15.4M	$2.4K
Trinity Care Providers Inc	IL	In Home Supportive Care Agency	$0	$3.7M
Laxmi Deshabathini	IL	Family Nurse Practitioner	$3.3M	$13.7K
Ritesh Patel	IL	Internal Medicine Physician	$255.6K	$2.2M
Solomon Sager	IL	Clinical Cardiac Electrophysiology Physician	$1M	$236.9K
Mednow Laboratory LLC	IL	Clinical Medical Laboratory	$1.1M	$0
Parag Doshi	IL	Interventional Cardiology Physician	$885K	$122.5K
Aasita Patel	IL	Cardiovascular Disease Physician	$843.1K	$72.5K
Elsayed Mohamed	IL	Interventional Cardiology Physician	$790K	$38.8K

Prism Health Care Services, Inc. — Billing Profile & Reimbursement Data

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Prism Health Care Services, Inc. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References