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 1689129496)

Prisma Health-upstate is a general acute care hospital provider located in Greenville, South Carolina. This profile covers 0 Medicare and 52 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Prisma Health-upstate
Address	900 W Faris Rd
City	Greenville
State	SC
ZIP	29605
Taxonomy	General Acute Care Hospital
NPI Enumerated	August 22, 2016

Payer Source	Total Paid
Medicaid	$3.4M
Medicare	$0

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

52 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	19,670	$130	$2.5M
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	19,970	$20	$459.3K
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.	16,620	$10	$166.2K
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…	4,160	$10	$54.1K
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…	350	$110	$37.2K
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.	290	$130	$37.2K
85007	The lab analyst performs a technical lab test on stained blood smears to microscopically examine and manually count and differentiate white blood cells, or WBCs, also called leukocytes. The…	8,260	$1	$24.8K
85027	The lab analyst performs a blood count on the red and white blood cells and platelets also known as thrombocytes. He also determines the hemoglobin, typically by spectrophotometry, and the…	21,330	$1	$21.3K
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.	2,600	$10	$20.8K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	270	$70	$19K

Showing 1–10 of 52

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 — 6 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

52 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.	43	210	1,470	$60	$615K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	510	650	800	$120	$413.8K
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…	415	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	36	710	350	$60	$247.2K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	83	100	1,390	$80	$246.6K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	1,359	2,480	350	$80	$246K
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.	83	100	2,200	$50	$238K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	85	100	4,180	$30	$200.5K
J7040	Infusion, normal saline solution, sterile (500 ml = 1 unit)	50	70	590	$100	$192.3K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	48	70	320	$40	$159.1K

Showing 1–10 of 52

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

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

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