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 Hawaii for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Hawaii 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. Hawaii (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.

Oahu Gastroenterology Inc (NPI 1083769756)

Oahu Gastroenterology Inc is a gastroenterology physician provider located in Honolulu, Hawaii. This profile covers 0 Medicare and 9 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Oahu Gastroenterology Inc
Address	405 N Kuakini St
City	Honolulu
State	HI
ZIP	96817
Taxonomy	Gastroenterology Physician
NPI Enumerated	January 24, 2007

Payer Source	Total Paid
Medicaid	$448.4K
Medicare	$0

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	1,120	$120	$132.6K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	540	$210	$113.1K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	3,010	$40	$108.2K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	620	$100	$60K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	160	$160	$25.3K
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	230	$20	$4.4K
99153	The provider performing a diagnostic or therapeutic procedure administers medication to reduce consciousness, but not render the patient unconscious or asleep, beyond the 15 minutes of intraservice…	470	$10	$2.8K
99152	The provider performing a diagnostic or therapeutic procedure administers medication to reduce consciousness, but not render the patient unconscious or asleep, in a patient five years of age or…	390	$10	$2K
99072	The provider uses items, supplies materials, or requires clinical staff time in excess of what is normally used or provided for an office visit or other nonfacility encounter. These additional items…	350	$0	$0

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Hawaii providers billing the same CPT/HCPCS codes.

Claims Volume vs. Hawaii Distribution

Oahu Gastroenterology Inc — 1 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	142	710	650	$90	$274.1K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	5	20	90	$550	$222.1K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	3	20	190	$340	$177.3K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	10	30	100	$280	$111.1K
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	63	170	120	$70	$35.7K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	4	20	170	$90	$32K
99152	The provider performing a diagnostic or therapeutic procedure administers medication to reduce consciousness, but not render the patient unconscious or asleep, in a patient five years of age or…	8	20	110	$20	$7.8K
99072	The provider uses items, supplies materials, or requires clinical staff time in excess of what is normally used or provided for an office visit or other nonfacility encounter. These additional items…	40	90	240	$1	$2.5K
99153	The provider performing a diagnostic or therapeutic procedure administers medication to reduce consciousness, but not render the patient unconscious or asleep, beyond the 15 minutes of intraservice…	1	10	260	$10	$1.4K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Liberty Dialysis - Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$42.8M
Kalihi Palama Health Center	HI	Federally Qualified Health Center (FQHC)	$0	$38.9M
Careresource Hawaii	HI	Home Health Agency	$0	$12.8M
Lanakila Pacific	HI	Home Delivered Meals	$0	$11.7M
Usrc Aloha LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$11.1M
Kuakini Medical Center	HI	General Acute Care Hospital	$0	$10.9M
Usrc Honolulu, LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$8.1M
Dialysis Newco LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$6.3M
Ku Aloha Ola Mau	HI	Counselor	$220.5K	$5.8M
Dialysis Newco LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$4.9M

Oahu Gastroenterology Inc — Billing Profile & Reimbursement Data

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Oahu Gastroenterology Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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Frequently Asked Questions

References