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 1669951364)

Field	Value
Entity Type	Organization
Organization	Prisma Health-upstate
Address	1807a E Main St
City	Easley
State	SC
ZIP	29640
Taxonomy	General Acute Care Hospital
NPI Enumerated	August 13, 2018

Payer Source	Total Paid
Medicaid	$1.8M
Medicare	$0

Medicaid: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	10,170	$100	$1M
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.	10,980	$40	$428.3K
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…	10,660	$30	$298.3K

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 3 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

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	79	340	2,970	$80	$711.1K
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.	71	350	2,590	$70	$550.2K
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…	53	290	2,600	$60	$414.4K

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
Pickens County Board Of Disabilities And Special Needs	SC	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$20.3M
Woodruff Road Urgent Care Center, P.C.	SC	Urgent Care Clinic/Center	$0	$7.3M
School District Of Pickens County	SC	Local Education Agency (LEA)	$0	$6.4M
National Seating & Mobility Inc	SC	Durable Medical Equipment & Medical Supplies	$0	$4.7M
Prisma Health University Medical Group	SC	Family Medicine Physician	$0	$4.7M
Pickens County Commission On Alcohol & Drug Abuse	SC	Substance Use Disorder Rehabilitation Clinic/Center	$0	$2.4M
Recovery Concepts Of Carolina Upst LLC	SC	Methadone Clinic	$0	$2.3M
Upstate Oral & Maxillofacial Surgery & Dental Implant Center, P.A.	SC	Oral and Maxillofacial Surgery (Dentist)	$0	$1.6M
Freedom 1st Medical Transport	SC	Land Ambulance	$534.1K	$0
Steven Freeman	SC	Internal Medicine Physician	$432.8K	$0

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