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.

Spartanburg Medical Center (NPI 1609807122)

Field	Value
Entity Type	Organization
Organization	Spartanburg Medical Center
Address	101 E Wood St
City	Spartanburg
State	SC
ZIP	29303
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 5, 2006

Payer Source	Total Paid
Medicaid	$187.7M
Medicare	$0

Key Findings

SPARTANBURG MEDICAL CENTER is effectively a single-payer Medicaid hospital in the available data: there is no Medicare billing on file and total Medicaid revenue is $187.7M. Analysts should treat Medicare-side comparisons as not applicable for this facility and focus competitive analysis on Medicaid activity and state peer benchmarks.

Revenue is meaningfully concentrated in a small set of high-volume codes: the precomputed top 3 Medicaid codes (80053, Q9967, J7040) account for 26.5% of the provider's total Medicaid revenue. That level of concentration signals that a relatively small set of services — led by a comprehensive metabolic panel (80053), iodinated contrast (Q9967), and saline infusion units (J7040) — are primary revenue drivers for the facility.

The code mix indicates a hybrid acute and high-throughput diagnostic operation: very large volumes of lab testing (80053, 80048, 81001, 81025) and molecular diagnostics (87636, U0003) paired with high-volume imaging/contrast use (Q9967, A9552) suggest substantial on-site laboratory and imaging capacity supporting both inpatient and outpatient throughput. These diagnostic-heavy revenue streams are complemented by dominant infusion supply codes (J7040, J7030, J7050, J7120), which further point to frequent IV/infusion activity consistent with hospital and ED workflows.

SPARTANBURG demonstrates dominant statewide standing on many high-volume Medicaid codes. Examples include 80053 (ranks #2 of 212 in-state, 100th percentile; extreme outlier), J7040 and J7030 (each rank #1 in their respective provider counts, 100th percentile; extreme outlier), 81001 and 81025 (each rank #1 in-state, 100th percentile; extreme outlier), and 87636 (ranks #1 of 69, 100th percentile; extreme outlier). These rank and percentile positions indicate the provider is a major Medicaid volume leader in South Carolina for core lab, infusion, and certain ED/diagnostic services.

Outpatient and therapy service lines are also significant revenue contributors: high claim volumes for 99213 (110.8K claims, $7.9M revenue, ranks #10 of 2766 in-state, 100th percentile; extreme outlier), 99214, and therapy codes 97110 and 97530 (each among the top in-state ranks) indicate broad ambulatory clinic and rehabilitation activity that extends the hospital’s Medicaid footprint beyond acute inpatient care. This mix suggests payer discussions should account for both ED/inpatient capacity and ongoing outpatient clinic and therapy utilization.

Emergency and transport activity is substantial, supporting a high-throughput ED and EMS interface: ED E/M codes 99283 and 99282 appear among the top Medicaid drivers (128.4K claims for 99283 and 15.2K for 99282) and ambulance codes A0427 and A0429 together contribute multiple millions in revenue. These volumes, combined with top-percentile ranks (e.g., 99283 ranks #4 of 341, 99th percentile), imply systematic emergency intake and frequent transport relationships that are important for capacity planning and network contracting.

The provider’s laboratory and infectious-disease testing capacity shows high throughput during the COVID era and beyond: 87636 (SARS–CoV-2/influenza multiplex) has 29.6K claims and ranks #1 in-state (100th percentile; extreme outlier), and U0003 also appears in the top code list with 16.8K claims. Those volumes, together with large numbers of routine chemistries and basic panels, reflect both diagnostic breadth and the ability to process high volumes of acute and surveillance testing for the Medicaid population.

SPARTANBURG’s NPI tenure (enumerated 2006-07-05, ~20 years ago) indicates a long-established presence in the market; when combined with extensive high-percentile rankings across labs, infusions, ED services, ambulances, outpatient E/M, and therapy codes, the data portray a mature, high-volume Medicaid hospital that functions as a regional service hub in South Carolina. This longevity plus concentrated revenue drivers should inform partner engagement, utilization management, and capacity-focused negotiations.

Medicaid: Complete Services Breakdown

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

632 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.	164,070	$100	$16.6M
Q9967	Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	28,980	$340	$9.8M
J7040	Infusion, normal saline solution, sterile (500 ml = 1 unit)	18,710	$480	$9M
J7030	Infusion, normal saline solution , 1000 cc	46,510	$180	$8.3M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	110,820	$70	$7.9M
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.	128,420	$60	$7.3M
J7050	Infusion, normal saline solution, 250 cc	12,260	$500	$6.1M
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	58,380	$100	$6M
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…	105,410	$60	$5.9M
J7120	Ringers lactate infusion, up to 1000 cc	20,990	$270	$5.7M

Showing 1–10 of 632

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

Spartanburg Medical Center — 22 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

632 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1745	Injection, infliximab, excludes biosimilar, 10 mg	3	10	810	$1,040	$1.7M
A9552	Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries	3	20	350	$1,170	$776.4K
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…	8	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.	2	210	1,470	$60	$615K
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	3	90	1,720	$90	$577.3K
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.	7	350	2,590	$70	$550.2K
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	4	90	1,720	$110	$525.8K
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.	4	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.	9	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.	10	200	1,680	$50	$443.2K

Showing 1–10 of 632

Related Providers

Other providers that share a Tax Identification Number (TIN) with Spartanburg Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spartanburg Medical Center	SC	Emergency Medicine Physician	$0	$17.2M
Spartanburg Medical Center	SC	Family Medicine Physician	$0	$17M
Cherokee Medical Center	SC	General Acute Care Hospital	$0	$15.4M
Pelham Medical Center	SC	General Acute Care Hospital	$0	$13.8M
Spartanburg Medical Center	SC	Maternal & Fetal Medicine Physician	$0	$11.5M
Union Medical Center	SC	General Acute Care Hospital	$0	$10.7M
Spartanburg Medical Center	SC	Community Based Hospice Care Agency	$0	$8.9M
Spartanburg Medical Center	SC	Urgent Care Clinic/Center	$0	$6.3M
Spartanburg Medical Center	SC	Pediatrics Physician	$0	$4.8M
Spartanburg Medical Center	SC	Urgent Care Clinic/Center	$0	$4.2M

Nearby Providers

Other providers in the same ZIP code as Spartanburg Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Axcess Healthcare Services, LLC	SC	Nursing Care Agency	$0	$98.5M
South Carolina Dept Of Mental Health Accounting Office	SC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$40M
Better Beginnings, Inc	SC	Pediatric Occupational Therapist	$0	$6.9M
Whitney Road Dental Health Center, P.C.	SC	General Practice Dentistry	$0	$6.3M
Foothills Pediatric Dentistry, PA	SC	Pediatric Dentistry	$0	$4.9M
Bhg Xxxviii, LLC	SC	Substance Use Disorder Rehabilitation Clinic/Center	$264.8K	$3.5M
Upstate Carolina Radiology PA	SC	Diagnostic Radiology Physician	$0	$3.2M
Jonathan Mims	SC	General Practice Dentistry	$0	$3.2M
Spartanburg Medical Center	SC	Pediatrics Physician	$0	$2.5M
Spartanburg & Pelham Ob-gyn,p.a.	SC	Obstetrics Physician	$0	$2M

Spartanburg Medical Center — 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