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

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

Utah Gastroenterology LLC (NPI 1972510717)

Utah Gastroenterology LLC is a gastroenterology physician provider located in Salt Lake City, Utah. This profile covers 0 Medicare and 15 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	Utah Gastroenterology LLC
Address	6360 South 3000 East
City	Salt Lake City
State	UT
ZIP	84121
Taxonomy	Gastroenterology Physician
NPI Enumerated	August 2, 2006

Payer Source	Total Paid
Medicaid	$613.8K
Medicare	$0

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	920	$170	$154.6K
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…	520	$200	$102.8K
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…	350	$250	$87.8K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	1,260	$60	$80.6K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	730	$90	$65.6K
43249	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum and dilates (widens) the esophagus with a balloon less than 30 mm in diameter.	60	$460	$26K
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	140	$190	$25.5K
43235	The provider inserts an endoscope through the mouth and down into the esophagus, stomach, and duodenum for diagnostic purposes; the provider may collect specimens by brushing or washing.	140	$140	$20.2K
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…	480	$40	$18.8K
00731	The anesthesia provider performs anesthesia services for an unspecified type of upper gastrointestinal endoscopic procedure during which another provider introduces the endoscope to but not beyond…	40	$270	$12K

Showing 1–10 of 15

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Utah Gastroenterology LLC — 0 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

15 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	277	1,340	200	$80	$144K
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…	449	1,360	190	$70	$125K
00813	The anesthesia provider performs anesthesia services for a patient undergoing both upper and lower intestinal endoscopy where the surgical provider introduces an endoscope into the intestines above…	3	10	420	$170	$94.5K
00731	The anesthesia provider performs anesthesia services for an unspecified type of upper gastrointestinal endoscopic procedure during which another provider introduces the endoscope to but not beyond…	7	10	60	$160	$86.3K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	16	20	750	$50	$74.4K
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…	85	90	140	$90	$56K
00812	The provider performs anesthesia services for a patient undergoing a screening colonoscopy during which the surgical provider introduces an endoscope into the intestines below the duodenum, the part…	3	10	50	$160	$55.4K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	29	270	80	$100	$41.6K
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.	12	50	250	$80	$40.9K
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…	207	290	100	$70	$37.1K

Showing 1–10 of 15

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Evolve Emod LLC	UT	Home Modifications Contractor	$0	$23.9M
Mountain Land Rehabilitation LLC	UT	Physical Therapist	$0	$4M
Rosewood Assisted Care Inc	UT	Assisted Living Facility	$0	$3.2M
Bristol Hospice - Utah Ii, L.L.C.	UT	Community Based Hospice Care Agency	$0	$2.6M
Journey Treatment Center	UT	Substance Abuse Rehabilitation Facility	$0	$1.9M
Douglas Toole	UT	Foot & Ankle Surgery Podiatrist	$1.6M	$0
Big Smiles Utah P.C.	UT	Dentist	$0	$1.3M
J Q Medical Supply, LLC	UT	Durable Medical Equipment & Medical Supplies	$0	$1.2M
Transport Connection, Inc	UT	Private Vehicle	$0	$806.7K
Innovation Medical Group PC	UT	Podiatrist	$0	$741.2K

Utah Gastroenterology LLC — Billing Profile & Reimbursement Data

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Utah Gastroenterology LLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Marcia Davis	UT	Acute Care Nurse Practitioner	$823.3K	$0
James Bown	UT	Gastroenterology Physician	$385.5K	$0
Peter Fenton	UT	Gastroenterology Physician	$251.5K	$0
Brien Miller	UT	Gastroenterology Physician	$209.6K	$0
George Jeung	UT	Gastroenterology Physician	$146K	$0
Ashlee Walker	UT	Family Nurse Practitioner	$139.9K	$0
Christoph Woerlein	UT	Gastroenterology Physician	$128K	$0
David Trowbridge	UT	Gastroenterology Physician	$77.4K	$0
Nekenzie Jones	UT	Family Nurse Practitioner	$67.4K	$0
Brett Doxey	UT	Gastroenterology Physician	$55.4K	$0