This provider's $4.2M in total Medicare payments ranks in the 99th percentile of Gastroenterology providers nationally.
Medicare payments to this provider grew 136% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 54% in 2021
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 | $848.80 | $177.78 | 4.77x | $671.02 | $289.2K | 2.8K | 1.8K |
| 2015 | $482.10 | $144.45 | 3.34x | $337.65 | $354.8K | 3.6K | 2.2K |
| 2016 | $550.49 | $170.49 | 3.23x | $380.00 | $396.9K | 4.1K | 2.2K |
| 2017 | $455.59 | $121.07 | 3.76x | $334.52 | $284.0K | 2.9K | 1.8K |
| 2018 | $530.50 | $157.27 | 3.37x | $373.23 | $345.0K | 3.5K | 2.2K |
| 2019 | $486.70 | $159.44 | 3.05x | $327.26 | $347.0K | 3.3K | 2.1K |
| 2020 | $451.21 | $145.23 | 3.11x | $305.98 | $337.7K | 3.4K | 2.0K |
| 2021 | $480.46 | $160.62 | 2.99x | $319.84 | $519.9K | 5.1K | 3.0K |
| 2022 | $473.00 | $147.94 | 3.20x | $325.06 | $621.5K | 6.3K | 3.6K |
| 2023 | $487.96 | $145.31 | 3.36x | $342.65 | $683.6K | 7.0K | 4.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 20.4K | $1.2M | $61.12 | 2.59x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 7.2K | $1.2M | $162.16 | 2.78x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 3.2K | $294.3K | $92.07 | 3.84x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.4K | $282.6K | $82.81 | 3.14x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.7K | $177.9K | $107.24 | 3.52x |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 826 | $159.6K | $193.22 | 2.38x |
| 43246 | Insertion of stomach tube using an endoscope | 710 | $121.5K | $171.16 | 2.96x |
| 45385 | Removal of polyps or growths of large bowel using an endoscope | 517 | $106.8K | $206.59 | 3.33x |
| 45380 | Biopsy of large bowel using an endoscope | 603 | $91.0K | $150.97 | 3.92x |
| 45388 | Destruction of large bowel growths using an endoscope | 377 | $86.7K | $229.95 | 3.11x |
| 43264 | Removal of stone from bile or pancreatic duct using an endoscope | 234 | $49.3K | $210.78 | 4.29x |
| 91110 | Imaging of digestive tract done from the inside of the digestive tract | 57 | $43.6K | $765.71 | 3.15x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 355 | $42.2K | $118.97 | 2.69x |
| 43235 | Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope | 418 | $39.7K | $95.06 | 3.16x |
| 45378 | Diagnostic examination of large bowel using an endoscope | 246 | $39.5K | $160.70 | 3.43x |
| 43274 | Placement of stent pancreatic or bile duct using an endoscope | 95 | $36.9K | $388.27 | 3.01x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 224 | $34.1K | $152.12 | 2.96x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 372 | $32.6K | $87.58 | 2.66x |
| G6024 | Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare tehnique | 74 | $19.5K | $263.57 | 2.71x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 326 | $19.2K | $58.81 | 3.01x |
This provider submits charges 2.96 times higher than what Medicare actually pays.
A markup ratio of 2.96x means for every $100 Medicare pays, this provider initially charges $296. 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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