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 1770039885)

Field	Value
Entity Type	Organization
Organization	Prisma Health-upstate
Address	701 Grove Rd
City	Greenville
State	SC
ZIP	29605
Taxonomy	Infusion Therapy Clinic/Center
NPI Enumerated	August 29, 2016

Payer Source	Total Paid
Medicaid	$7.5M
Medicare	$0

Medicaid: Complete Services Breakdown

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

50 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J9271	Injection, pembrolizumab, 1 mg	250	$9,030	$2.2M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	810	$1,390	$1.1M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	9,520	$90	$847.6K
J1459	Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg	460	$1,450	$671.9K
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.	5,890	$50	$318K
J1439	Injection, ferric carboxymaltose, 1 mg	300	$760	$225.3K
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	9,520	$20	$190.3K
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	250	$770	$189.6K
36430	In this procedure, the provider punctures and places a catheter into a vein to transfuse blood or blood components directly into the patient’s bloodstream.	1,180	$150	$181.9K
96417	In this add–on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report administration of a different chemotherapy…	2,310	$60	$129.3K

Showing 1–10 of 50

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 — 5 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

50 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1745	Injection, infliximab, excludes biosimilar, 10 mg	4	10	810	$1,040	$1.7M
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	2	10	250	$1,580	$769.5K
J7030	Infusion, normal saline solution , 1000 cc	37	70	2,620	$60	$337.3K
J9271	Injection, pembrolizumab, 1 mg	5	10	380	$540	$322.1K
J7050	Infusion, normal saline solution, 250 cc	46	50	1,140	$100	$309.2K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	5	50	520	$110	$277.4K
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.	18	100	1,390	$80	$246.6K
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.	33	100	2,200	$50	$238K
96367	The provider administers an additional intravenous infusion or infusions, after an initial infusion, of a different medication or substance for a period up to one hour to prevent, treat, or diagnose…	5	40	580	$160	$229.6K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	58	100	4,180	$30	$200.5K

Showing 1–10 of 50

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
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 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
Shriners Hospitals For Children	SC	Children's Hospital	$0	$4.3M

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