This provider's $7.0M 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.
Notable: Payments increased 66% 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 | $427.03 | $140.63 | 3.04x | $286.40 | $635.7K | 6.6K | 5.8K |
| 2015 | $417.26 | $140.04 | 2.98x | $277.22 | $508.7K | 4.4K | 3.8K |
| 2016 | $382.95 | $127.03 | 3.01x | $255.92 | $719.3K | 6.9K | 6.0K |
| 2017 | $470.33 | $137.02 | 3.43x | $333.31 | $688.2K | 6.0K | 5.0K |
| 2018 | $465.32 | $135.57 | 3.43x | $329.75 | $839.5K | 7.1K | 6.0K |
| 2019 | $419.27 | $121.16 | 3.46x | $298.11 | $945.0K | 8.1K | 6.7K |
| 2020 | $405.45 | $132.06 | 3.07x | $273.39 | $566.5K | 5.2K | 4.5K |
| 2021 | $398.64 | $147.14 | 2.71x | $251.50 | $938.0K | 9.3K | 7.9K |
| 2022 | $410.30 | $141.98 | 2.89x | $268.32 | $695.8K | 6.9K | 6.0K |
| 2023 | $489.66 | $132.40 | 3.70x | $357.26 | $508.4K | 5.0K | 4.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 91110 | Imaging of digestive tract done from the inside of the digestive tract | 1.2K | $844.6K | $695.72 | 2.87x |
| 87507 | Detection test for digestive tract pathogen | 1.4K | $666.5K | $466.10 | 2.57x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 7.5K | $663.1K | $87.86 | 5.16x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 7.5K | $653.1K | $87.28 | 1.97x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 4.2K | $517.6K | $124.07 | 2.10x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 7.0K | $418.2K | $59.32 | 2.17x |
| 46221 | Removal of hemorrhoid by rubber banding | 1.6K | $372.0K | $227.51 | 2.43x |
| 76700 | Ultrasound of abdomen | 4.3K | $357.1K | $83.31 | 2.62x |
| 45388 | Destruction of large bowel growths using an endoscope | 949 | $225.3K | $237.42 | 2.65x |
| U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r | 2.7K | $202.7K | $75.24 | 2.66x |
| 45385 | Removal of polyps or growths of large bowel using an endoscope | 1.1K | $186.0K | $174.60 | 4.85x |
| 46600 | Diagnostic examination of the anus using an endoscope | 2.0K | $168.4K | $82.35 | 1.66x |
| 45380 | Biopsy of large bowel using an endoscope | 1.2K | $168.1K | $135.11 | 5.12x |
| 45378 | Diagnostic examination of large bowel using an endoscope | 962 | $154.8K | $160.93 | 3.89x |
| 91120 | Testing of tone and sensation of rectum and anus | 262 | $98.2K | $374.91 | 3.35x |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 467 | $92.6K | $198.39 | 2.85x |
| 88312 | Special stained specimen slides to identify organisms including interpretation and report | 1.1K | $86.6K | $78.93 | 1.90x |
| 43249 | Balloon dilation of esophagus using an endoscope | 742 | $86.1K | $115.97 | 3.49x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 1.5K | $84.5K | $57.77 | 2.59x |
| 96413 | Infusion of chemotherapy into a vein up to 1 hour | 782 | $84.4K | $107.91 | 2.77x |
This provider submits charges 2.95 times higher than what Medicare actually pays.
A markup ratio of 2.95x means for every $100 Medicare pays, this provider initially charges $295. 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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