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.

Roper Hospital, Inc (NPI 1962472860)

Key Findings

Field	Value
Entity Type	Organization
Organization	Roper Hospital, Inc
Address	316 Calhoun St
City	Charleston
State	SC
ZIP	29401
Taxonomy	General Acute Care Hospital
NPI Enumerated	January 24, 2006

Payer Source	Total Paid
Medicaid	$22.1M
Medicare	$0

Roper Hospital reports $22.1M in lifetime Medicaid revenue and has no Medicare billing on file, making its public claims footprint effectively single‑payer (Medicaid) in the dataset. Its NPI was enumerated on 2006-01-24 (~20 years ago), indicating an established provider presence in the market for roughly two decades.

Revenue is highly concentrated in a small set of services: the precomputed top three Medicaid codes account for 40.0% of the provider’s total Medicaid revenue. Those top three are 99283 ($3.7M, 21.0%), 99282 ($1.8M, 10.5%), and 87636 ($1.5M, 8.5%), underscoring a reliance on a few high-volume procedures.

The code mix points to a heavy emergency department and acute care operational model: high-volume E/M codes 99283 (63.2K claims) and 99282 (14.2K claims) dominate revenue, and 99284 also appears with very large claim volume (32.6K claims) despite lower average payment. This pattern suggests the hospital handles large ED throughput with a mix of low-to-moderate acuity encounters rather than being dominated by higher‑acuity, higher-reimbursement inpatient DRG activity.

On-site laboratory and diagnostic testing are major service lines for Medicaid patients: 80048 (24.5K claims), 81003 (20.4K claims), and multiplex respiratory testing 87636 (10.1K claims) generate material revenue. 81003 is called out as an extreme outlier (rank #8 of 495, 99th percentile) and 87636 ranks #2 of 69 (99th percentile), indicating unusually high state-level throughput for basic urinalysis and multiplex viral testing.

Competitive standing in the state is strong for ED and testing codes: 99283 ranks #9 of 341 providers in-state (98th percentile), 99282 ranks #8 of 138 (95th percentile), and 87636 ranks #2 of 69 (99th percentile). Those ranks and percentiles characterize Roper as a major statewide provider for emergency visits and SARS–CoV‑2/influenza multiplex testing rather than a modest participant.

Ancillary services that support urgent care and short infusions are also prominent: 96374 (14.8K claims, $902.1K revenue) and 96360 ($417.9K revenue) indicate frequent rapid IV medication and fluid/rehydration interventions, while imaging codes such as 74177 (5.6K claims) and 70450 (5K claims) show routine CT capacity to support ED presentations. Together these codes portray a full ED ecosystem with on-site imaging and infusion capability.

Payment mix across high-volume codes is uneven: some high-volume items carry low per-claim payments (for example 99284 at $15 avg paid/claim despite 32.6K claims), while others receive higher reimbursement per claim (99282 at $128 avg and 87636 at $147 avg). This dispersion suggests revenue sensitivity to changes in case mix and reimbursement rates across both E/M and laboratory services.

Because 40.0% of Medicaid revenue is concentrated in the top three codes, the provider’s Medicaid revenue stream is sensitive to shifts in ED visit volumes or laboratory testing demand and reimbursement. That concentration, combined with the absence of Medicare billing on file, means operational or policy changes that affect ED or lab utilization in the Medicaid population could materially impact overall reported revenue.

Medicaid: Complete Services Breakdown

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

225 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	63,220	$60	$3.7M
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.	14,230	$130	$1.8M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	10,120	$150	$1.5M
81003	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dipstick, and shakes off the excess urine. She places the stick onto a mechanical dip stick reader that will…	20,430	$70	$1.4M
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…	24,540	$60	$1.3M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	14,790	$60	$902.1K
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.	17,600	$50	$792K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	12,980	$60	$753.1K
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…	11,240	$50	$550.9K
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.	32,560	$20	$488.3K

Showing 1–10 of 225

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

Roper Hospital, Inc — 7 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

225 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.	42	210	1,470	$60	$615K
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	72	90	1,720	$90	$577.3K
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.	103	350	2,590	$70	$550.2K
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	58	90	1,720	$110	$525.8K
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.	9	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.	24	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.	33	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…	43	60	170	$430	$434.9K
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.	8	140	2,520	$90	$415.3K
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…	83	290	2,600	$60	$414.4K

Showing 1–10 of 225

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Roper St Francis Ancillary Services	SC	Home Health Agency	$0	$3.3M
Jason Goebel	SC	Clinical Cardiac Electrophysiology Physician	$643.3K	$0
Jeffrey Rieder	SC	Interventional Cardiology Physician	$554.1K	$0
Troy Bunting	SC	Cardiovascular Disease Physician	$461.3K	$0
Matthew O'steen	SC	Interventional Cardiology Physician	$449.6K	$0
Lars Runquist	SC	Interventional Cardiology Physician	$412.2K	$0
Wills Geils	SC	Specialist	$409.7K	$0
Scott Woodfield	SC	Interventional Cardiology Physician	$383.3K	$0
Minh Tran	SC	Cardiovascular Disease Physician	$310.4K	$0
Kenneth Desart	SC	Vascular Surgery Physician	$310K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Charleston County School District	SC	Local Education Agency (LEA)	$0	$12.7M
Susan Yonce	SC	Family Nurse Practitioner	$2.3M	$0
Michael Spandorfer	SC	Pulmonary Disease Physician	$246.4K	$0
James Carswell	SC	Critical Care Medicine (Internal Medicine) Physician	$222K	$0
Johnny Campbell	SC	Diagnostic Radiology Physician	$213.4K	$0
Jeffery Bennett	SC	Diagnostic Radiology Physician	$201.7K	$0
Robert Lowery	SC	Orthopaedic Surgery Physician	$197.6K	$0
Edward Butler	SC	Procedural Dermatology Physician	$184.7K	$0
Catherine Johnson-gough	SC	Diagnostic Radiology Physician	$179.4K	$0
Andrew Barnes	SC	Neuroradiology Physician	$178.9K	$0

Roper Hospital, Inc — 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