NEVVI Medicare utilization intelligence

The average upper-GI endoscopy was billed to Medicare at about $1,010 in 2024 — Medicare paid about $98

Published Jul 2026 · CMS Part B PUF 📋 Cite See the data →
Average submitted charge vs. Medicare payment · upper-GI endoscopy · 2024
Billed (avg): $1,010$1,010Billed (avg)Paid (avg): $98$98Paid (avg)
Average Medicare fee-for-service submitted charge and payment per upper-GI endoscopy — the physician's professional service, not the separate facility charge — across named physician groups, 2024. Full method below.
How unevenly the gap is spread
$0$1,250$2,500++97 groups list more, to $21,078 →one dot = one physician groupmedian group $800

The services-weighted average of $1,010 is pulled up by a right tail: the median group lists about $800, while the highest-listing tenth list about $1,660 or more.

Each dot is one of 2,345 named physician groups, placed by its average submitted charge per upper-GI endoscopy in 2024. Submitted charges are provider-set list amounts, not payments — the spread is list-price behavior, not what Medicare pays.
How the gap has moved
20202021202220232024$1,010$98Billed (avg)Paid (avg)

The gap widened over 2020 to 2024 — from about 8.4 to about 10.4 times as much billed as paid.

The average submitted charge moved from $879 to $1,010 and the average Medicare payment from $104 to $98. Payment tracks the Medicare fee schedule; the gap reflects list prices set above it, not a change in what care cost.

Charged about 10.4 times what it paid: for the average upper-GI endoscopy in 2024, these groups billed about $1,010 and Medicare paid about $98.

The gap is a list price set against a fee schedule. Submitted charges are amounts each group sets on its own. Medicare pays its allowed amount for the procedure, whatever the list price.

Medicare is one payer. The submitted charge is a list price, and a higher one does not raise Medicare's payment. The gap measures a list price against one payer's schedule, from Medicare claims only. It says nothing about what any other payer pays.

This is the professional service only. The separate hospital or surgery-center facility charge for the procedure is not included.

A record of what was billed and what Medicare paid — not a verdict on price, value, or fairness. The charge is a list amount each group sets; the payment is the fee schedule's fixed amount.

What this is

The average submitted charge and the average Medicare payment per upper-GI endoscopy (physician professional service), across named physician groups, in 2024.

What it is not

Not a total-spending figure, not the facility charge and not all-payer.

How this is counted
Average submitted charge and average Medicare payment per upper-GI endoscopy, across named physician groups, 2024 — a per-service average and its ratio, not a total. This is the physician's professional service, not the hospital facility charge. Because these are per-service averages and a ratio, they are NOT scaled to total Medicare — a per-service figure is basis-independent, so no estimate or MA assumption applies. Cells under 11 beneficiaries withheld by CMS. Excludes commercial payers. Source: Medicare Part B.

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