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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
43191 Diagnostic exam of esophagus using an endoscope CPT · Procedure
Classification Procedure Digestive/Gastrointestinal Upper GI Endoscopy (CMS RBCS)
First observed 2014
National scale 833 services ▼ 9.8% YoY · 753 beneficiaries (CY2024, Medicare FFS)
Medicare paid $69K · $82.78 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups
12
Named-group FFS services
715
FFS of Medicare
49%
Services YoY
-9.8%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~1,547 services

715 observed fee-for-service (46%) · ~832 estimated Medicare Advantage. Scaled from the observed floor by each state’s fee-for-service share (FFS share as of 2024) — scaled estimate — assumes MA utilization mirrors FFS; not an observation. How we scale

Top states — 43191 (CY2024)

Disclosed Medicare fee-for-service services by billing state; open a bar for that state's ranked market.

Named-group submitted charges
$291K
Named-group allowed amount
$61K
Named-group Medicare payments
$48K
Avg charge / svc
$407
Avg allowed / svc
$85
Avg payment / svc
$67
Average charge per group
$159 12 groups · avg submitted charge / service $1,276
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Data year: CY2024 CY2023 CY2022 locked column CY2021 locked column CY2020 locked column
Physician groups ranked by 43191 services, highest first, CY2024
# Physician group activate to sort City activate to sort St activate to sort Specialty activate to sort Providers activate to sort 43191 svcs sorted descending — activate to reverse Submitted charges activate to sort Avg charge activate to sort Medicare $ locked column Share* activate to sort Phone
1 TEXAS HEALTH CARE PLLC FORT WORTH TX NURSE PRACTITIONER 364 207 $70,602 $341 premium 38.3% (817) 920-0484
2 CHRISTUS TRINITY CLINIC TYLER TX NURSE PRACTITIONER 1495 167 $87,007 $521 premium 30.9% (903) 606-5560
3 EAR NOSE AND THROAT SPECIALTY CARE PLLC DALLAS TX OTOLARYNGOLOGY 8 155 $24,701 $159 premium 28.7% (214) 826-3681
4 UNIVERSITY OF MIAMI MIAMI FL NURSE PRACTITIONER 2331 49 $31,126 $635 premium 55.1% (305) 689-5437
5 OSU OTOLARYNGOLOGY HEAD AND NECK SURGERY LLC COLUMBUS OH OTOLARYNGOLOGY 67 22 $11,880 $540 premium 100.0% (614) 366-3687
6 THE QUEENS MEDICAL CENTER HONOLULU HI NURSE PRACTITIONER 190 22 $8,690 $395 premium 100.0%
7 OROHEALTH CORPORATION A NON PROFIT HEALTHCARE SYSTEM OROVILLE CA INTERNAL MEDICINE 124 20 $11,100 $555 premium 100.0% (530) 532-8654
8 NORTH FLORIDA SURGEONS PA JACKSONVILLE FL PHYSICIAN ASSISTANT 331 20 $7,900 $395 premium 22.5% (904) 396-1725
9 NORTH SHORE-LIJ MEDICAL PC MANHASSET MI PHYSICIAN ASSISTANT 6294 15 $19,140 $1,276 premium 100.0%
10 LEHIGH VALLEY PHYSICIAN GROUP ALLENTOWN PA PHYSICIAN ASSISTANT 2389 15 $5,110 $341 premium 100.0%
11 EASTERN CAROLINA EAR, NOSE AND THROAT-HEAD AND NECK SURGERY, INC GREENVILLE NC OTOLARYNGOLOGY 17 12 $7,200 $600 premium 50.0% (252) 752-5227
12 OU HEALTH PARTNERS INC OKLAHOMA CITY OK PHYSICIAN ASSISTANT 1160 11 $6,212 $565 premium 100.0% (405) 271-4311

*Share of the state's disclosed Medicare-FFS services for the primary code, counted once per clinician. "St" is the state the volume was billed from: a group appears in each state where its clinicians bill Medicare, with that state's volume and share ("City" is the group's registered location). Group figures sum clinicians affiliated with exactly one group; clinicians in several groups are listed in each group's drill-down but not volume-attributed to any single group, so shares reflect attributable volume. See Methods.

Comparing against an all-payer estimate?

These are exact counts from Medicare fee-for-service claims — roughly a third to half of most procedure markets, depending on payer mix. Modeled all-payer databases project the remainder statistically; we publish the audited floor and label it as such. Same market, different denominator. How the numbers reconcile →