Lexington Medical Center said it received approval from state regulators to perform open-heart surgery.
The unit could be open within a year, the hospital said Thursday.
Lexington will get one of Providence Hospitals four open-heart surgery units. In exchange, Lexington will pay Providence $15 million and drop its protest of Providences proposed expansion in Northeast Richland.
The unique settlement ended a costly five-year dispute between the hospitals.
Lexington has been able to diagnose heart patients and perform emergency angioplasties, but must transfer patients needing more critical care to existing heart units at Providence and Palmetto Health in downtown Columbia.
The S.C. Department of Health and Environmental Control, which regulates hospitals, had rejected Lexingtons previous proposals to add heart units in the area, fearing expansion would spread surgical talent too thin.