This provider's $5.8M 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 | $615.26 | $144.23 | 4.27x | $471.03 | $552.7K | 4.8K | 2.3K |
| 2015 | $677.27 | $145.04 | 4.67x | $532.23 | $530.6K | 4.7K | 1.9K |
| 2016 | $740.00 | $147.03 | 5.03x | $592.97 | $505.5K | 4.5K | 2.0K |
| 2017 | $754.44 | $155.97 | 4.84x | $598.47 | $546.6K | 5.1K | 2.0K |
| 2018 | $759.69 | $142.03 | 5.35x | $617.66 | $575.6K | 5.2K | 2.0K |
| 2019 | $771.77 | $152.10 | 5.07x | $619.67 | $660.7K | 5.9K | 2.1K |
| 2020 | $649.10 | $131.94 | 4.92x | $517.16 | $573.1K | 5.4K | 1.4K |
| 2021 | $778.40 | $134.63 | 5.78x | $643.77 | $518.0K | 4.6K | 1.6K |
| 2022 | $650.71 | $124.22 | 5.24x | $526.49 | $644.6K | 5.9K | 1.8K |
| 2023 | $670.27 | $113.60 | 5.90x | $556.67 | $696.8K | 6.2K | 1.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 32.3K | $2.9M | $88.21 | 1.58x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 5.5K | $894.5K | $163.88 | 1.95x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 3.8K | $691.0K | $182.12 | 1.54x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 1.6K | $269.9K | $166.68 | 1.92x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.4K | $223.7K | $93.56 | 1.46x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 1.7K | $147.7K | $88.63 | 9.59x |
| 43246 | Insertion of stomach tube using an endoscope | 709 | $120.2K | $169.54 | 8.84x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 873 | $109.5K | $125.44 | 1.62x |
| 45385 | Removal of polyps or growths of large bowel using an endoscope | 485 | $101.7K | $209.74 | 7.61x |
| 45378 | Diagnostic examination of large bowel using an endoscope | 636 | $101.6K | $159.78 | 5.32x |
| 43274 | Placement of stent pancreatic or bile duct using an endoscope | 182 | $70.3K | $386.17 | 3.51x |
| 45380 | Biopsy of large bowel using an endoscope | 471 | $58.6K | $124.46 | 7.59x |
| 43235 | Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope | 281 | $27.3K | $97.14 | 7.72x |
| 99354 | Prolonged office or other outpatient service first hour | 279 | $23.6K | $84.60 | 1.39x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 170 | $21.2K | $124.50 | 2.17x |
| 43275 | Removal of foreign body or stent from pancreatic or bile duct using an endoscope | 73 | $19.1K | $261.23 | 4.55x |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 92 | $18.1K | $196.28 | 4.33x |
| 43264 | Removal of stone from bile or pancreatic duct using an endoscope | 190 | $16.5K | $86.91 | 18.24x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 187 | $11.3K | $60.36 | 1.66x |
| 43262 | Incision of pancreatic outlet muscle using an endoscope | 120 | $5.5K | $45.94 | 21.08x |
This provider submits charges 2.39 times higher than what Medicare actually pays.
A markup ratio of 2.39x means for every $100 Medicare pays, this provider initially charges $239. 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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