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 Medical Group-midlands (NPI 1871080283)

Prisma Health Medical Group-midlands is a family medicine physician provider located in Sumter, South Carolina. This profile covers 0 Medicare and 55 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 Medical Group-midlands
Address	115 N Sumter St Ste 400
City	Sumter
State	SC
ZIP	29150
Taxonomy	Family Medicine Physician
NPI Enumerated	April 20, 2018

Payer Source	Total Paid
Medicaid	$3.6M
Medicare	$0

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

55 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	34,680	$60	$2.1M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	8,190	$40	$302.9K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	1,310	$110	$140.4K
99203	The provider sees a new 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 provider…	1,690	$60	$103.3K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	1,660	$60	$101.3K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	1,120	$80	$92.2K
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…	1,520	$60	$89.5K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	2,400	$30	$76.8K
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,…	2,280	$30	$68.3K
20610	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	2,980	$20	$50.7K

Showing 1–10 of 55

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 Medical Group-midlands — 4 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

55 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	47	60	50	$960	$381.4K
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…	62	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	60	710	350	$60	$247.2K
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…	737	2,480	350	$80	$246K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	9	60	350	$190	$230.8K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	78	100	240	$100	$187.3K
59514	The provider admits the patient to the hospital for delivery, delivers the fetus and placenta via an abdominal incision, and provides care immediately after delivery on the same date of service. This…	14	20	30	$480	$164.8K
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…	123	410	330	$50	$152.6K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	29	230	430	$40	$129.9K
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,…	77	610	190	$50	$98.4K

Showing 1–10 of 55

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health University Medical Group	SC	Family Medicine Physician	$0	$171.7M
Prisma Health Medical Group-midlands	SC	Multi-Specialty Clinic/Center	$0	$77.6M
Centra Medical Group, LLC	VA	Family Medicine Physician	$0	$60.1M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$28.1M
Prisma Health-upstate	SC	Developmental Disabilities Clinic/Center	$0	$19.7M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$10.9M
Prisma Health Medical Group-midlands	SC	Orthopaedic Surgery Physician	$0	$8.7M
Greenville Proaxis Therapy, LLC	SC	Physical Therapist	$0	$7.9M
Prisma Health Tuomey	SC	Emergency Medicine Physician	$0	$6.8M
Prisma Health Medical Group-midlands	SC	Developmental - Behavioral Pediatrics Physician	$0	$5.9M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sumter Pediatrics, P.A.	SC	Pediatrics Physician	$0	$24.4M
Tandem Health Sc	SC	Federally Qualified Health Center (FQHC)	$0	$17.3M
Colonial Family Practice, LLC	SC	Family Medicine Physician	$0	$9.5M
Tandem Health Sc	SC	Federally Qualified Health Center (FQHC)	$0	$7.8M
Wesmark Dental Health Center	SC	General Practice Dentistry	$0	$6.3M
Addus Healthcare (south Carolina), Inc.	SC	In Home Supportive Care Agency	$0	$5.5M
Carolina Children's Dentistry, LLC	SC	Pediatric Dentistry	$0	$5.2M
Sumter School District	SC	Local Education Agency (LEA)	$0	$4.2M
Kool Smiles, PC	SC	General Practice Dentistry	$0	$4.2M
Sumter County Ems	SC	Ambulance	$971.3K	$3M

Prisma Health Medical Group-midlands — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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