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 1487868097)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prisma Health-midlands
Address	3301 Harden Street
City	Columbia
State	SC
ZIP	29203
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 10, 2007

Payer Source	Total Paid
Medicaid	$68.3M
Medicare	$0

PRISMA HEALTH-MIDLANDS reports no Medicare billing on file and is effectively a single‑payer (Medicaid) inpatient/outpatient operator in the available data; total Medicaid revenue on file is $68.3M and Medicare revenue is listed as none. This concentration means analyses of utilization and competitive position should focus on Medicaid lines of business rather than Medicare fee‑for‑service patterns.

Revenue concentration within Medicaid is high: the precomputed top‑3 Medicaid codes account for 30.1% of this provider’s total Medicaid revenue. The top three revenue drivers are 36415 ($5.7M, 12.2%), 97110 ($5.5M, 11.7%), and 70553 ($2.9M, 6.1%), indicating a relatively small set of codes generate a large share of Medicaid dollars.

The mix of high‑volume codes points to a full‑service acute hospital with substantial lab, imaging, ED, therapy, and infusion activity. High counts for lab panels and specimen codes (36415: 52.6K claims; 80048: 42.3K claims; 80053: 40.8K claims) alongside substantial MRI brain volume (70553: 2.7K claims) and therapeutic exercise (97110: 84.4K claims) suggest broad outpatient diagnostic, emergency, and rehabilitative services co‑located with hospital resources.

Several individual codes are statistical outliers in‑state, signaling dominant market positions for specific services. 97110 ranks #3 of 285 providers in‑state at the 99th percentile and is labeled an "extreme outlier," while 36415 ranks #12 of 713 providers at the 98th percentile and is also called an "extreme outlier." Additionally, 80069 ranks #1 of 62 providers at the 100th percentile (extreme outlier), indicating unusually high state volume for renal function testing.

The provider is a major in‑state outpatient clinic and infusion/ED activity center: G0463 (hospital outpatient clinic visit) has 32.6K claims, $1.5M revenue and ranks #3 of 65 providers at the 97th percentile (extreme outlier). High volumes of infusion and injection codes (96365, 96372, 96361, 96360) — each contributing meaningful revenue and ranking well above typical state volume — reflect heavy infusion and ED treatment throughput.

Emergency department and outpatient evaluation activity is prominent in the Medicaid mix. ED E/M codes 99283 and 99282 together represent notable revenue ($2.5M and $1.6M respectively) and both rank well above typical state volume (96th and 93rd percentiles), indicating a high ED visit volume and significant Medicaid ED reimbursement streams.

Operational risk and contracting implications arise from the observed concentration: with 30.1% of Medicaid revenue concentrated in the top three codes, changes in reimbursement, prior‑authorization, or utilization management for high‑volume services like phlebotomy (36415) and therapeutic exercise (97110) could materially affect facility revenue. Payers and network managers should prioritize review of outpatient therapy, lab panels, and MRI utilization when assessing cost and network adequacy for this provider.

Tenure and registry data indicate a stable presence in the market: the NPI was enumerated on 2007-05-10 (~19 years ago), supporting interpretation of these utilization patterns as established operational behavior rather than a short‑term anomaly. Given the breadth and depth of high‑percentile code volumes across labs, imaging, ED, clinic visits, and infusion services, PRISMA HEALTH-MIDLANDS appears to be a long‑standing, high‑throughput Medicaid provider in South Carolina.

Medicaid: Complete Services Breakdown

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

562 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.	52,570	$110	$5.7M
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…	84,390	$70	$5.5M
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…	2,690	$1,060	$2.9M
80048	The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood…	42,330	$60	$2.7M
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.	51,880	$50	$2.5M
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…	19,820	$120	$2.4M
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.	40,780	$50	$2.2M
70551	The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam.	3,530	$550	$1.9M
84156	The lab analyst performs a test to evaluate the level of total protein in a urine specimen by a lab method other than refractometry or dipstick.	1,760	$970	$1.7M
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.	12,540	$130	$1.6M

Showing 1–10 of 562

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 — 17 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

562 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	4	10	340	$1,490	$1.1M
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…	66	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.	14	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.	43	350	2,590	$70	$550.2K
T1015	Clinic visit/encounter, all-inclusive	332	350	3,560	$30	$525.5K
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.	14	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.	32	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.	20	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…	8	60	170	$430	$434.9K
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.	6	20	380	$520	$421.9K

Showing 1–10 of 562

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 Medical Group-midlands	SC	Orthopaedic Surgery Physician	$0	$8.7M
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
Joel Waldrop	SC	Emergency Medicine Physician	$2.4M	$9.3K

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	$28.1M
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