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 1649726738)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prisma Health-upstate
Address	701 Grove Rd
City	Greenville
State	SC
ZIP	29605
Taxonomy	General Acute Care Hospital
NPI Enumerated	August 29, 2016

Payer Source	Total Paid
Medicaid	$86.9M
Medicare	$0

PRISMA HEALTH-UPSTATE is effectively a Medicaid-centric provider: it has no Medicare billing on file and reports lifetime Medicaid revenue of $86.9M. This single-payer footprint on file indicates the provider’s measurable claims activity in our dataset is concentrated in state Medicaid rather than Medicare.

Revenue is notably concentrated in a small set of codes: the top three Medicaid codes (80053, 36415, 99283) account for 32.3% of the provider’s total Medicaid revenue. Those three codes individually are 80053 ($7.3M, 12.1%), 36415 ($6.5M, 10.8%), and 99283 ($5.6M, 9.3%), showing a heavy contribution from lab panels, phlebotomy, and emergency department E/M encounters.

The code mix signals a high-throughput acute-care and emergency operations model: 99283 and 99282 together represent substantial ED visit volume (99283 $5.6M and 99282 $4.1M), while phlebotomy 36415 ($6.5M) and lab panels 80053 ($7.3M) and 80048 ($3.5M) show integrated, high-volume diagnostic services. Coupled with frequent use of IV administration codes (96361, 96360, 96365, 96374, 96372), the profile is consistent with an ED and hospital outpatient setting that delivers frequent IV therapies and rapid diagnostic testing.

PRISMA’s competitive standing in-state is strong for many high-volume codes: several codes are described as extreme outliers or notably above typical state volume and rank at the top of statewide lists. Examples include 96361 (rank #1 of 103, 100th percentile; $2.5M), 96360 (rank #1 of 81, 100th percentile; $1.7M), 80053 (rank #3 of 212, 99th percentile; $7.3M), and 36415 (rank #4 of 713, 100th percentile; $6.5M), indicating PRISMA is a major Medicaid provider for ED-related treatments and diagnostic throughput within South Carolina.

High-value imaging and specialized diagnostics contribute materially to Medicaid revenue and reflect advanced outpatient capability: 70553 ($4.3M, 7.1% of Medicaid revenue) and 70551 ($2.7M, 4.5%) show significant MRI volume, while A9552 ($2.9M, 4.8%) and PLA code 0202U ($1M, 1.7%) point to higher-priced radiopharmaceutical and proprietary lab testing. These items are higher per-claim payments (e.g., 70553 at $1,116 avg paid/claim and A9552 at $1,780 avg paid/claim) and indicate capacity for complex diagnostic procedures beyond routine lab work.

The provider was enumerated on 2016-08-29 (~10 years ago), giving it an established presence in state Medicaid billing that aligns with the high statewide ranks and extreme-volume labels observed across many codes. Ten years of enumeration supports the interpretation that these volumes represent sustained operational scale rather than a transient reporting spike.

COVID and infectious disease testing are a material component of outpatient testing volume: C9803 (SARS‑CoV‑2 specimen collection) is $1.8M (3.0% of Medicaid revenue) and ranks #1 of 46 providers in-state (100th percentile), while U0003 PCR testing is $1.6M (2.7%) and ranks #4 of 87 (97th percentile). These entries, alongside high counts for respiratory and PLA panels (0202U), indicate substantial diagnostic testing throughput tied to infectious disease surveillance in the outpatient setting.

Although revenue is spread across many procedure types, several codes are extreme outliers in statewide comparisons, signaling operational concentration in ED visits, common lab panels, phlebotomy, and IV therapies. The combined pattern—top 3 codes representing 32.3% of Medicaid revenue, numerous 100th‑percentile ranks, and large claim counts for routine diagnostics and ED services—suggests PRISMA derives a large share of its Medicaid revenue from high-volume, lower-margin throughput activities supplemented by higher-margin imaging and specialized tests.

Medicaid: Complete Services Breakdown

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

574 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.	105,840	$70	$7.3M
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	71,610	$90	$6.5M
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.	93,540	$60	$5.6M
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…	3,850	$1,120	$4.3M
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.	28,540	$150	$4.1M
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…	56,820	$60	$3.5M
A9552	Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries	1,630	$1,780	$2.9M
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.	4,620	$590	$2.7M
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.	40,800	$60	$2.5M
86850	The lab analyst performs a screening test using patient blood to determine the presence of any antibodies to red blood cells, called RBCs, other than the A and B antigens.	17,520	$100	$1.8M

Showing 1–10 of 574

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 — 19 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

574 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1745	Injection, infliximab, excludes biosimilar, 10 mg	5	10	810	$1,040	$1.7M
A9552	Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries	4	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…	254	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.	3	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.	95	350	2,590	$70	$550.2K
T1015	Clinic visit/encounter, all-inclusive	339	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.	5	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.	10	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.	2	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…	4	60	170	$430	$434.9K

Showing 1–10 of 574

Prisma Health-upstate — Billing Profile & Reimbursement Data

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Prisma Health-upstate — 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-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
Greenville Health Corporation	SC	Durable Medical Equipment & Medical Supplies	$0	$8.9M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Heavenly Care Services Inc.	SC	Nursing Care Agency	$0	$12.1M
Speechworks, Inc.	SC	Speech-Language Pathologist	$0	$10.5M
Plan Home Health Care	SC	Nursing Care Agency	$0	$8.9M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$8.3M
Prisma Health-upstate	SC	Land Ambulance	$4.5M	$3.7M
Prisma Health-upstate	SC	Infusion Therapy Clinic/Center	$0	$7.5M
Prisma Health University Medical Group	SC	Diagnostic Radiology Physician	$0	$7.5M
Carolina Family Services Of Greenville LLC	SC	Community/Behavioral Health Agency	$0	$6M
New Horizon Family Health Services, Inc.	SC	Federally Qualified Health Center (FQHC)	$0	$5.8M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$4.6M