This provider's $5.2M in total Medicare payments ranks in the 99th percentile of Gastroenterology providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
AI-generated analysis based on Medicare payment data.
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 | $492.77 | $150.14 | 3.28x | $342.63 | $637.0K | 6.8K | 4.7K |
| 2015 | $445.67 | $137.35 | 3.24x | $308.32 | $639.8K | 7.1K | 4.8K |
| 2016 | $410.59 | $129.19 | 3.18x | $281.40 | $626.8K | 7.2K | 5.0K |
| 2017 | $430.69 | $132.14 | 3.26x | $298.55 | $633.3K | 7.6K | 5.3K |
| 2018 | $383.61 | $130.71 | 2.93x | $252.90 | $574.4K | 6.4K | 4.7K |
| 2019 | $454.51 | $140.97 | 3.22x | $313.54 | $583.6K | 6.1K | 4.4K |
| 2020 | $571.69 | $191.10 | 2.99x | $380.59 | $508.0K | 4.4K | 3.1K |
| 2021 | $329.69 | $131.34 | 2.51x | $198.35 | $305.9K | 3.3K | 2.2K |
| 2022 | $604.81 | $189.34 | 3.19x | $415.47 | $357.0K | 3.3K | 2.3K |
| 2023 | $575.23 | $171.60 | 3.35x | $403.63 | $347.3K | 2.9K | 2.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 12.3K | $709.1K | $57.72 | 2.45x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 7.7K | $645.2K | $84.17 | 2.45x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 10.7K | $613.5K | $57.58 | 2.42x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 3.4K | $543.7K | $159.64 | 2.48x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 4.7K | $419.6K | $89.90 | 4.35x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 3.3K | $398.5K | $120.39 | 2.69x |
| 45385 | Removal of polyps or growths of large bowel using an endoscope | 1.6K | $364.0K | $220.71 | 3.08x |
| 45380 | Biopsy of large bowel using an endoscope | 2.3K | $330.5K | $143.65 | 4.03x |
| 43249 | Balloon dilation of esophagus using an endoscope | 413 | $284.8K | $689.69 | 2.49x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 1.4K | $150.6K | $109.19 | 2.50x |
| 91110 | Imaging of digestive tract done from the inside of the digestive tract | 398 | $130.0K | $326.51 | 3.29x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.0K | $87.2K | $84.12 | 2.40x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.0K | $73.5K | $73.02 | 2.88x |
| 43251 | Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope | 401 | $65.4K | $163.14 | 3.37x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 1.5K | $47.7K | $31.08 | 2.54x |
| 45378 | Diagnostic examination of large bowel using an endoscope | 298 | $41.4K | $138.90 | 2.93x |
| 46221 | Removal of hemorrhoid by rubber banding | 178 | $39.4K | $221.37 | 2.31x |
| 43450 | Dilation of esophagus | 1.1K | $38.2K | $34.06 | 5.56x |
| 45398 | Tying of large bowel using an endoscope | 56 | $32.3K | $576.38 | 2.47x |
| 43246 | Insertion of stomach tube using an endoscope | 173 | $29.5K | $170.26 | 3.21x |
This provider submits charges 2.87 times higher than what Medicare actually pays.
A markup ratio of 2.87x means for every $100 Medicare pays, this provider initially charges $287. 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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