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-upstate (NPI 1538615653)

Field	Value
Entity Type	Organization
Organization	Prisma Health-upstate
Address	440 Roper Mountain Rd
City	Greenville
State	SC
ZIP	29615
Taxonomy	Home Health Agency
NPI Enumerated	August 29, 2016

Payer Source	Total Paid
Medicaid	$1.6M
Medicare	$0

Medicaid: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1030	Nursing care, in the home, by registered nurse, per diem	12,430	$90	$1.1M
S9131	Physical therapy; in the home, per diem	3,670	$100	$355.8K
A9900	Miscellaneous dme supply, accessory, and/or service component of another hcpcs code	1,330	$140	$181.4K
S9129	Occupational therapy, in the home, per diem	350	$100	$32.9K
S9127	Social work visit, in the home, per diem	30	$70	$2.3K

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-upstate — 0 of 5 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

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1030	Nursing care, in the home, by registered nurse, per diem	10	50	3,370	$90	$545.7K
S9131	Physical therapy; in the home, per diem	19	40	2,390	$100	$393.9K
S9129	Occupational therapy, in the home, per diem	18	30	630	$100	$188.2K
A9900	Miscellaneous dme supply, accessory, and/or service component of another hcpcs code	4	10	560	$110	$120.8K
S9127	Social work visit, in the home, per diem	3	10	40	$80	$3.4K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health University Medical Group	SC	Family Medicine Physician	$0	$171.7M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$86.9M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$25M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$22M
Prisma Health-upstate	SC	Developmental Disabilities Clinic/Center	$0	$19.7M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$15.6M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$13.1M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$10.9M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$10.7M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$9.3M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Childrens Medical Center	SC	Specialist	$0	$17.1M
Prisma Health University Medical Group	SC	Developmental - Behavioral Pediatrics Physician	$0	$16M
Agapi Behavioral Consultants	SC	Behavior Analyst	$0	$15M
St Francis Hospital, Inc.	SC	General Acute Care Hospital	$0	$13M
Eastside Pediatric Dentistry PA	SC	Pediatric Dentistry	$0	$10M
Magnolia Medical Group Inc	SC	Physical Therapist	$0	$9.9M
Greenville Health Corporation	SC	Durable Medical Equipment & Medical Supplies	$0	$8.9M
D&s Community Services Sc, LLC	SC	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$8.3M
Bloom Behavioral Therapy LLC	SC	Mental Health Counselor	$0	$7.5M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$6.4M

Prisma Health-upstate — Billing Profile & Reimbursement Data

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Prisma Health-upstate — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References