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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Joshua Spaete (NPI 1730342239)

Joshua Spaete is a gastroenterology physician provider located in Durham, North Carolina. This profile covers 12 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Provider details (source: NPPES NPI Registry)

Medicare: Complete Services Breakdown

Field	Value
Entity Type	Individual
Organization	Joshua Spaete
Address	40 Duke Medicine Cir
City	Durham
State	NC
ZIP	27710
Taxonomy	Gastroenterology Physician
NPI Enumerated	July 3, 2008

Payer Source	Total Paid
Medicare	$39.4K
Medicaid	$0

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	60	$170	$9.3K
43237	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum; he also inserts an ultrasound transducer through the scope to examine these same…	30	$130	$4.4K
43274	The physician performs an ERCP (a diagnostic procedure that combines upper endoscopy and retrograde (reverse or backward) injection of contrast material, a type of dye, into the biliary ducts to…	10	$310	$4.3K
43238	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he carries out an ultrasound–guided, intramural or transmural fine needle…	20	$170	$4K
45390	The provider performs flexible colonoscopy along with excision of mucous membrane tissue using an endoscope.	20	$240	$3.6K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	20	$130	$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.	60	$40	$2.8K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	40	$60	$2.1K
43264	The provider performs a diagnostic procedure that combines upper endoscopy and retrograde (reverse) injection of contrast material, a type of dye, into the biliary ducts to obtain fluoroscopic images…	20	$130	$2.1K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	20	$100	$2K

Showing 1–10 of 12

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
45385	333	560	70	$290	$33.4K
45380	379	520	40	$180	$13.7K
45390	20	40	20	$500	$11.6K
43239	256	560	60	$120	$11K
43274	33	40	20	$310	$8.3K
99232	4,005	5,690	70	$60	$8.1K
99215	4,210	5,720	40	$110	$7.7K
99223	2,820	4,580	30	$130	$6.5K
43237	4	20	20	$130	$3.3K
43238	3	20	20	$160	$3.3K

Joshua Spaete — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References