Medicaid Provider SpendingClaims paid 2018–2024 · HHS public file
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Hospital

Prisma Health-Upstate

Prisma Health-Upstate was paid $15.64M by Medicaid between Jan 2018 and Dec 2024, across 253 billing codes. Its largest line is 36415, Collection of venous blood by venipuncture — 26% of everything it billed.

33Billing provider infoPRISMA HEALTH-UPSTATE
SENECA, SC 29672
33aNPI1063968196assigned 08/29/2016
33bProvider typeGeneral Acute Care Hospital
28Total paid$15.64M
24GClaims680,726
24DCodes billed253
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers

Next to other General Acute Care Hospital providers in South Carolina

Rank by total paid#21 of 115
Median peer was paid$2.47M
This provider vs. median6.3×

Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.

Auditor's notes

Automated statistical signals. Not evidence of fraud — how these are computed.

Entity ProliferationAuthorized official MILLER, POLLY controls 20+ related entities in our dataset. Read more
Box 24A · Dates of service

Paid by month

$0$100K$200K$300K2018201920202021202220232024
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
YearClaimsPaid
201889,417$2.06M
2019101,832$2.00M
202095,960$2.06M
2021101,041$2.33M
2022104,428$2.66M
202398,771$2.52M
2024incomplete89,277$2.02M
Box 24 · Service lines

What it billed for

CodeServiceShareClaimsBene. recordsPaid
36415 Collection of venous blood by venipuncture 26% 47,939 35,599 $4.13M
99283 Emergency room visit (moderate)Emergency department visit for the evaluation and management, moderate severity 7.4% 32,067 29,635 $1.15M
99282 Emergency department visit for the evaluation and management, low to moderate severity 6.5% 7,667 7,404 $1.01M
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular 4.7% 11,316 7,126 $732K
0241U Neonatal screening for hereditary disorders, genomic sequence analysis panel 3.7% 7,038 6,726 $575K
96361 Intravenous infusion, hydration; each additional hour 2.9% 12,754 9,690 $451K
97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion 2.9% 6,412 2,212 $446K
C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source 2.4% 4,913 4,593 $371K
96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance 2.2% 11,517 10,246 $340K
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour 2.0% 5,267 4,435 $308K
81025 2.0% 11,087 10,228 $308K
81001 2.0% 18,163 16,361 $307K
241 more codes
80053 Comprehensive metabolic panel 2.0% 24,213 $306K
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder 1.9% 4,674 $292K
96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour 1.6% 3,456 $248K
82565 1.1% 735 $180K
71260 Computed tomography, thorax, diagnostic; with contrast material 1.1% 869 $175K
80307 Drug test(s), presumptive, any number of drug classes; immunoassay 1.0% 6,374 $162K
70553 Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences 1.0% 202 $161K
87086 Culture, bacterial; quantitative colony count, urine 1.0% 9,696 $158K
86850 <1% 2,602 $139K
71046 Radiologic examination, chest; 2 views <1% 6,850 $137K
99284 Emergency room visit (serious) <1% 18,446 $133K
80048 Basic metabolic panel (calcium, ionized) <1% 16,561 $129K
97530 Therapeutic activities, direct patient contact, each 15 minutes <1% 4,900 $129K
99281 Emergency department visit for the evaluation and management, self-limited or minor <1% 931 $127K
93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete <1% 1,246 $125K
70450 Computed tomography, head or brain; without contrast material <1% 4,632 $125K
87081 <1% 3,446 $120K
88305 Level IV - Surgical pathology, gross and microscopic examination <1% 1,784 $118K
73130 <1% 1,235 $116K
87804 Infectious agent antigen detection by immunoassay; Influenza, each type <1% 2,302 $99K
76830 Ultrasound, transvaginal <1% 678 $95K
81003 <1% 4,963 $94K
74177 Computed tomography, abdomen and pelvis; with contrast material <1% 4,940 $91K
99285 Emergency room visit (most serious) <1% 18,389 $89K
73110 <1% 989 $87K
73610 <1% 1,694 $84K
87077 <1% 4,182 $83K
73630 <1% 1,732 $80K
99213 Doctor's office visit, returning patient (routine) <1% 2,442 $78K
93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report <1% 14,945 $76K
76705 Ultrasound, abdominal, real time with image documentation; limited <1% 1,928 $71K
74176 Computed tomography, abdomen and pelvis; without contrast material <1% 2,212 $65K
71045 Radiologic examination, chest; single view <1% 8,719 $65K
76801 <1% 602 $65K
87210 <1% 1,642 $62K
87070 <1% 1,654 $54K
99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward <1% 1,109 $53K
71250 <1% 268 $52K
73030 <1% 1,172 $49K
93971 <1% 375 $45K
80047 <1% 2,022 $37K
85025 Blood count; complete (CBC), automated, and automated differential WBC count <1% 39,178 $34K
87651 Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe <1% 1,484 $33K
87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe <1% 1,941 $33K
12001 <1% 297 $31K
87637 Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV <1% 590 $27K
96376 <1% 4,460 $27K
71275 Computed tomographic angiography, chest, with contrast material <1% 1,360 $27K
G0378 Hospital observation service, per hour <1% 5,389 $26K
78452 Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress <1% 153 $26K
96375 Therapeutic injection; each additional sequential IV push <1% 9,371 $25K
72100 <1% 800 $24K
73564 <1% 654 $23K
U0003 Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r <1% 1,851 $21K
73090 <1% 244 $21K
93017 <1% 436 $21K
59025 Fetal non-stress test <1% 427 $19K
96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour <1% 2,979 $18K
74018 <1% 537 $16K
77067 Screening mammography, bilateral, including computer-aided detection <1% 555 $15K
73721 Magnetic resonance imaging, any joint of lower extremity; without contrast material <1% 29 $15K
84112 <1% 56 $15K
76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete <1% 891 $13K
88304 <1% 294 $12K
73080 <1% 167 $12K
J7120 Ringers lactate infusion, up to 1000 cc <1% 7,648 $12K
U0005 Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 <1% 944 $12K
99214 Doctor's office visit, returning patient (more involved) <1% 669 $11K
80061 Lipid panel <1% 3,535 $11K
73502 <1% 542 $11K
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml <1% 8,254 $9K
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A <1% 2,158 $9K
82950 <1% 920 $9K
80076 <1% 3,211 $8K
84443 Thyroid stimulating hormone (TSH) <1% 5,893 $8K
0202U Oncology (prostate), multianalyte, gene expression profiling <1% 43 $8K
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction <1% 3,699 $8K
87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies <1% 3,223 $7K
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine <1% 848 $7K
81511 <1% 13 $6K
J2550 Injection, promethazine hcl, up to 50 mg <1% 2,069 $6K
76770 <1% 114 $6K
J7030 Infusion, normal saline solution , 1000 cc <1% 14,011 $6K
J1650 Injection, enoxaparin sodium, 10 mg <1% 3,251 $6K
73560 <1% 135 $5K
77063 Screening digital breast tomosynthesis, bilateral <1% 56 $5K
87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe <1% 3,063 $5K
87807 <1% 393 $5K
84702 <1% 2,928 $4K
93225 <1% 13 $4K
72125 Computed tomography, cervical spine; without contrast material <1% 1,238 $4K
93970 <1% 24 $4K
J3490 Unclassified drugs <1% 5,693 $4K
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple <1% 540 $4K
J2405 Injection, ondansetron hydrochloride, per 1 mg <1% 11,154 $3K
97161 <1% 1,036 $3K
82247 <1% 420 $3K
84484 <1% 8,468 $3K
85027 <1% 4,643 $3K
76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal <1% 399 $3K
73140 <1% 41 $3K
93976 <1% 1,385 $3K
82962 <1% 29 $3K
76642 <1% 77 $3K
86900 <1% 3,036 $3K
70496 <1% 30 $3K
83735 <1% 7,790 $2K
J0696 Injection, ceftriaxone sodium, per 250 mg <1% 3,096 $2K
85007 <1% 803 $2K
J1815 Injection, insulin, per 5 units <1% 2,202 $2K
81220 CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants <1% 92 $2K
72040 <1% 37 $2K
12002 <1% 26 $2K
82570 <1% 986 $2K
99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes <1% 161 $2K
97165 <1% 170 $2K
84439 <1% 1,274 $2K
83880 <1% 2,631 $2K
86803 <1% 1,555 $2K
76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation <1% 16 $2K
86780 <1% 910 $2K
86762 <1% 1,009 $2K
92523 <1% 12 $2K
82105 <1% 29 $2K
J2270 Injection, morphine sulfate, up to 10 mg <1% 3,342 $2K
J1644 Injection, heparin sodium, per 1000 units <1% 1,069 $2K
J7040 Infusion, normal saline solution, sterile (500 ml = 1 unit) <1% 921 $1K
86140 <1% 2,543 $1K
82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed <1% 1,254 $1K
73660 <1% 12 $1K
85610 <1% 3,638 $1K
83036 Hemoglobin; glycosylated (A1C) <1% 2,763 $1K
82803 <1% 1,019 $1K
12011 <1% 15 $1K
69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia <1% 12 $1K
97116 <1% 414 $1K
J1100 Injection, dexamethasone sodium phosphate, 1 mg <1% 5,510 $1K
99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity <1% 40 $1K
82140 <1% 31 $1K
J2175 Injection, meperidine hydrochloride, per 100 mg <1% 1,115 $1K
J1170 Injection, hydromorphone, up to 4 mg <1% 4,220 $997.58
70498 <1% 41 $951.78
J2272 Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg <1% 1,199 $887.25
93922 <1% 13 $884.51
87040 <1% 2,513 $833.22
76775 <1% 24 $783.47
86901 <1% 3,037 $773.41
J1885 Injection, ketorolac tromethamine, per 15 mg <1% 8,805 $766.80
J1790 Injection, droperidol, up to 5 mg <1% 106 $764.44
97535 Self-care/home management training, each 15 minutes <1% 453 $743.96
J2930 Injection, methylprednisolone sodium succinate, up to 125 mg <1% 869 $738.47
J2250 Injection, midazolam hydrochloride, per 1 mg <1% 3,253 $725.02
80143 <1% 914 $685.83
87045 <1% 29 $653.39
A4300 Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access <1% 12 $536.44
76815 Ultrasound, pregnant uterus, real time with image documentation, limited <1% 27 $495.56
82607 <1% 309 $458.00
86592 <1% 365 $455.55
90715 <1% 687 $442.11
83540 <1% 142 $435.85
87661 Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe <1% 483 $419.67
A9502 Technetium tc-99m tetrofosmin, diagnostic, per study dose <1% 59 $396.86
J3370 Injection, vancomycin hcl, 500 mg <1% 179 $363.82
J3480 Injection, potassium chloride, per 2 meq <1% 195 $363.45
J1940 Injection, furosemide, up to 20 mg <1% 49 $356.46
90686 <1% 30 $356.46
97162 <1% 26 $353.55
73590 <1% 27 $289.18
82150 <1% 161 $253.17
87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe <1% 1,835 $230.08
82728 <1% 176 $228.60
G1004 Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program <1% 4,796 $215.30
85379 <1% 2,373 $183.38
82947 <1% 119 $166.21
87340 <1% 1,174 $159.27
86787 <1% 987 $158.66
83690 <1% 9,590 $157.62
83605 <1% 3,499 $148.76
82550 <1% 1,500 $128.14
84156 <1% 544 $106.80
82077 <1% 1,746 $103.81
62323 <1% 41 $99.40
A9585 Injection, gadobutrol, 0.1 ml <1% 789 $94.29
G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed <1% 13 $91.45
87186 <1% 3,063 $64.19
G0463 Hospital outpatient clinic visit for assessment and management of a patient <1% 24 $50.21
84550 <1% 422 $49.48
85730 <1% 2,387 $40.13
J0690 Injection, cefazolin sodium, 500 mg <1% 2,657 $38.38
85014 <1% 2,081 $30.97
84145 <1% 750 $28.76
80179 <1% 742 $23.49
J0780 Injection, prochlorperazine, up to 10 mg <1% 354 $23.33
J3010 Injection, fentanyl citrate, 0.1 mg <1% 3,175 $20.41
83655 <1% 14 $15.61
J0131 Injection, acetaminophen, not otherwise specified,10 mg <1% 503 $14.39
J0330 Injection, succinylcholine chloride, up to 20 mg <1% 601 $10.10
J1200 Injection, diphenhydramine hcl, up to 50 mg <1% 1,302 $6.32
85652 <1% 925 $4.90
85651 <1% 993 $3.65
85018 <1% 292 $2.49
J7512 Prednisone, immediate release or delayed release, oral, 1 mg <1% 2,108 $1.51
J2765 Injection, metoclopramide hcl, up to 10 mg <1% 432 $1.20
J2060 Injection, lorazepam, 2 mg <1% 560 $0.35
J3475 Injection, magnesium sulfate, per 500 mg 0% 1,009 $0.00
82248 0% 471 $0.00
84100 0% 428 $0.00
J0665 Injection, bupivicaine, not otherwise specified, 0.5 mg 0% 95 $0.00
96367 0% 408 $0.00
C1713 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) 0% 78 $0.00
J1596 Injection, glycopyrrolate, 0.1 mg 0% 61 $0.00
J2710 Injection, neostigmine methylsulfate, up to 0.5 mg 0% 197 $0.00
97168 0% 154 $0.00
76942 0% 84 $0.00
J2919 Injection, methylprednisolone sodium succinate, 5 mg 0% 44 $0.00
J1171 Injection, hydromorphone, 0.1 mg 0% 84 $0.00
87502 Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets 0% 29 $0.00
87075 0% 41 $0.00
84466 0% 38 $0.00
86336 0% 16 $0.00
J7510 Prednisolone oral, per 5 mg 0% 42 $0.00
76000 0% 26 $0.00
93308 0% 29 $0.00
51701 0% 59 $0.00
82010 0% 42 $0.00
86308 0% 103 $0.00
J2795 Injection, ropivacaine hydrochloride, 1 mg 0% 780 $0.00
J2785 Injection, regadenoson, 0.1 mg 0% 85 $0.00
83615 0% 294 $0.00
A9500 Technetium tc-99m sestamibi, diagnostic, per study dose 0% 82 $0.00
J2003 Injection, lidocaine hydrochloride, 1 mg 0% 65 $0.00
86580 0% 33 $0.00
87205 0% 291 $0.00
J8540 Dexamethasone, oral, 0.25 mg 0% 28 $0.00
J1040 Injection, methylprednisolone acetate, 80 mg 0% 30 $0.00
45380 Colonoscopy, flexible; with biopsy, single or multiple 0% 12 $0.00
82677 0% 16 $0.00
P9612 Catheterization for collection of specimen, single patient, all places of service 0% 152 $0.00
82746 0% 52 $0.00
88300 0% 12 $0.00
J2371 Injection, phenylephrine hydrochloride, 20 micrograms 0% 25 $0.00

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.

From NPPES

Who's on the registration

Authorized officialMILLER, POLLY (VP PAYOR STRATEGIES & ALIGNMENT)
Same official

Other billing entities under MILLER, POLLY

Full network →
ProviderLocationPaid
Prisma Health-MidlandsColumbia, SC$74.58M
Prisma Health-MidlandsColumbia, SC$68.26M
Prisma Health-UpstateGreenville, SC$25.04M
Prisma Health-UpstateGreenville, SC$21.98M
Prisma Health-UpstateGreenville, SC$19.69M
Prisma Health-MidlandsColumbia, SC$11.77M
Prisma Health-UpstateGreenville, SC$10.74M
Greenville Health CorporationGreenville, SC$8.90M
Prisma Health-UpstateGreenville, SC$8.32M
Prisma Health-UpstateGreenville, SC$7.45M
Prisma Health University Medical GroupGreenville, SC$7.44M
Prisma Health-MidlandsCoulmbia, SC$7.43M
Prisma Health-MidlandsColumbia, SC$6.88M
Prisma Health TuomeySumter, SC$6.84M
Prisma Health-MidlandsColumbia, SC$6.77M
Prisma Health-UpstateGreenville, SC$6.37M
Prisma Health-UpstateGreenville, SC$5.00M
Prisma Health-UpstateGreenville, SC$4.65M
Prisma Health-MidlandsColumbia, SC$4.63M
Prisma Health-UpstateSeneca, SC$4.48M

Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.