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 1538580584)

Field	Value
Entity Type	Organization
Organization	Prisma Health-midlands
Address	400 Palmetto Health Pkwy
City	Columbia
State	SC
ZIP	29212
Taxonomy	General Acute Care Hospital
NPI Enumerated	December 18, 2013

Payer Source	Total Paid
Medicaid	$3.1M
Medicare	$0

Medicaid: Complete Services Breakdown

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

137 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	7,470	$70	$485.7K
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…	6,800	$60	$387.7K
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.	11,320	$30	$328.3K
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.	2,230	$80	$180.4K
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	4,570	$40	$169K
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…	9,910	$10	$138.7K
0241U	N/A	2,680	$50	$120.7K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	5,430	$20	$119.5K
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.	5,680	$20	$107.9K
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…	3,370	$30	$104.6K

Showing 1–10 of 137

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 — 0 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

137 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.	69	210	1,470	$60	$615K
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.	78	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.	83	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.	63	200	1,680	$50	$443.2K
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.	72	140	2,520	$90	$415.3K
Q9967	Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	43	110	1,880	$100	$414K
J7030	Infusion, normal saline solution , 1000 cc	28	70	2,620	$60	$337.3K
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	150	2,500	$50	$324.9K
J7050	Infusion, normal saline solution, 250 cc	39	50	1,140	$100	$309.2K
0241U	N/A	23	50	1,840	$90	$291.4K

Showing 1–10 of 137

Nearby Providers

Other providers in the same ZIP code as Prisma Health-midlands, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Options, Inc.	SC	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$40.2M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$4.3M
School District 5 Of Lexington & Richland Counties	SC	Local Education Agency (LEA)	$0	$2.8M
Prisma Health Medical Group-midlands	SC	Interventional Cardiology Physician	$0	$2.5M
Kalpesh Purohit	SC	Family Medicine Physician	$2.1M	$0
Irmo Kids Dental LLC	SC	Dental Clinic/Center	$0	$1.8M
Play 2 Learn Early Intervention	SC	Early Intervention Provider Agency	$0	$1.7M
Counseling For Hope & Healing	SC	Professional Counselor	$0	$1.6M
Lexington Health Inc	SC	Ambulatory Surgical Clinic/Center	$792.7K	$22.3K
Lexington Health Inc	SC	Radiology Clinic/Center	$599.2K	$34.3K

Prisma Health-midlands — Billing Profile & Reimbursement Data

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Prisma Health-midlands — 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