This provider's $4.4M in total Medicare payments ranks in the 99th percentile of Gastroenterology providers nationally.
Their average markup ratio of 5.95x is significantly above the specialty median of 4.9x.
Medicare payments to this provider grew 765% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 132% in 2015
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2014 | $605.67 | $156.00 | 3.88x | $449.67 | $87.5K | 980 | 408 |
| 2015 | $616.67 | $147.51 | 4.18x | $469.16 | $202.8K | 2.5K | 973 |
| 2016 | $727.14 | $154.64 | 4.70x | $572.50 | $220.3K | 2.8K | 1.1K |
| 2017 | $1.2K | $147.17 | 7.98x | $1.0K | $337.8K | 4.5K | 1.4K |
| 2018 | $930.61 | $138.00 | 6.74x | $792.61 | $379.5K | 4.7K | 1.7K |
| 2019 | $919.11 | $136.68 | 6.72x | $782.43 | $452.0K | 6.2K | 2.2K |
| 2020 | $859.15 | $145.47 | 5.91x | $713.68 | $340.8K | 6.7K | 2.2K |
| 2021 | $393.58 | $152.35 | 2.58x | $241.23 | $784.9K | 9.2K | 3.4K |
| 2022 | $2.3K | $159.16 | 14.51x | $2.2K | $841.9K | 9.9K | 3.6K |
| 2023 | $1.9K | $147.02 | 13.16x | $1.8K | $757.1K | 8.9K | 3.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 35.3K | $2.4M | $66.64 | 5.91x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 3.9K | $681.6K | $177.05 | 7.00x |
| 99497 | Advance care planning by the physician or other qualified health care professional | 3.6K | $258.8K | $71.26 | 5.72x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 6.8K | $253.4K | $37.30 | 1.42x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 2.0K | $242.3K | $123.80 | 1.49x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 1.3K | $120.5K | $96.15 | 1.30x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 847 | $93.9K | $110.87 | 10.55x |
| 99356 | Prolonged inpatient or observation hospital service, first hour | 860 | $72.8K | $84.62 | 23.04x |
| 43246 | Insertion of stomach tube using an endoscope | 329 | $64.7K | $196.67 | 5.70x |
| 45378 | Diagnostic examination of large bowel using an endoscope | 326 | $58.2K | $178.59 | 6.45x |
| 99285 | Emergency department visit, problem with significant threat to life or function | 237 | $40.3K | $169.87 | 5.54x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 176 | $36.0K | $204.54 | 8.36x |
| 45380 | Biopsy of large bowel using an endoscope | 125 | $23.2K | $185.31 | 10.44x |
| 43264 | Removal of stone from bile or pancreatic duct using an endoscope | 110 | $22.7K | $206.78 | 9.23x |
| 43255 | Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope | 98 | $17.8K | $181.81 | 6.68x |
| 43274 | Insertion of stent into pancreatic or bile duct using a flexible endoscope via mouth | 39 | $15.5K | $397.12 | 6.30x |
| 43235 | Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope | 141 | $14.7K | $104.44 | 13.58x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 137 | $13.7K | $99.87 | 7.61x |
| 45384 | Removal of polyps or growths in large bowel using an endoscope | 31 | $7.1K | $230.05 | 4.52x |
| 45382 | Control of bleeding of upper large bowel using a flexible endoscope | 16 | $4.1K | $253.54 | 10.69x |
This provider submits charges 5.95 times higher than what Medicare actually pays.
A markup ratio of 5.95x means for every $100 Medicare pays, this provider initially charges $595. This is higher than the national average.
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Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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