This provider's $4.9M in total Medicare payments ranks in the 99th percentile of Gastroenterology providers nationally.
Medicare payments to this provider grew 98% from 2014 to 2023.
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 | $560.54 | $126.18 | 4.44x | $434.36 | $284.2K | 2.7K | 2.5K |
| 2015 | $485.06 | $113.42 | 4.28x | $371.64 | $345.6K | 3.3K | 2.8K |
| 2016 | $592.47 | $124.10 | 4.77x | $468.37 | $318.6K | 3.1K | 2.7K |
| 2017 | $516.62 | $143.79 | 3.59x | $372.83 | $445.0K | 3.6K | 2.9K |
| 2018 | $495.45 | $126.64 | 3.91x | $368.81 | $552.5K | 5.0K | 3.7K |
| 2019 | $521.92 | $115.62 | 4.51x | $406.30 | $541.5K | 6.1K | 3.9K |
| 2020 | $504.03 | $108.40 | 4.65x | $395.63 | $533.9K | 6.7K | 4.7K |
| 2021 | $433.37 | $109.36 | 3.96x | $324.01 | $657.2K | 7.3K | 5.6K |
| 2022 | $453.09 | $103.22 | 4.39x | $349.87 | $659.8K | 7.8K | 6.0K |
| 2023 | $419.16 | $85.62 | 4.90x | $333.54 | $563.7K | 7.0K | 5.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 11.7K | $974.9K | $83.32 | 1.54x |
| 43259 | Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope | 2.4K | $422.9K | $173.11 | 5.18x |
| 45385 | Removal of polyps or growths of large bowel using an endoscope | 2.0K | $397.1K | $203.53 | 3.98x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 4.9K | $397.0K | $81.31 | 1.49x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 3.3K | $389.1K | $117.39 | 1.63x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 2.5K | $384.5K | $153.97 | 1.52x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 4.9K | $240.5K | $49.57 | 8.97x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.4K | $238.7K | $54.61 | 1.66x |
| 45378 | Diagnostic examination of large bowel using an endoscope | 1.5K | $211.7K | $145.77 | 4.08x |
| 43249 | Balloon dilation of esophagus using an endoscope | 2.0K | $157.6K | $76.89 | 8.46x |
| 45380 | Biopsy of large bowel using an endoscope | 1.3K | $141.8K | $107.16 | 5.97x |
| 76981 | Elastography ultrasound of organ tissue | 1.5K | $113.3K | $74.33 | 1.33x |
| 76705 | Ultrasound of abdomen, limited | 1.8K | $111.0K | $60.96 | 1.61x |
| 76700 | Ultrasound of abdomen | 1.0K | $86.6K | $84.81 | 1.88x |
| 43242 | Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope | 407 | $85.8K | $210.91 | 5.63x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 636 | $74.6K | $117.37 | 1.43x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 391 | $62.2K | $159.01 | 1.38x |
| 43235 | Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope | 605 | $57.4K | $94.81 | 4.53x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 753 | $57.0K | $75.73 | 1.85x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 1.8K | $54.4K | $30.55 | 1.64x |
This provider submits charges 3.22 times higher than what Medicare actually pays.
A markup ratio of 3.22x means for every $100 Medicare pays, this provider initially charges $322. 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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