This provider's $5.6M in total Medicare payments ranks in the 99th percentile of Gastroenterology providers nationally.
Their average markup ratio of 8.36x is significantly above the specialty median of 4.9x.
Medicare payments to this provider grew 130% 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 | $881.30 | $132.79 | 6.64x | $748.51 | $322.6K | 3.8K | 1.4K |
| 2015 | $1.2K | $134.13 | 9.31x | $1.1K | $426.0K | 5.1K | 1.9K |
| 2016 | $1.2K | $126.08 | 9.26x | $1.0K | $410.1K | 5.0K | 1.8K |
| 2017 | $1.2K | $120.17 | 9.79x | $1.1K | $550.8K | 6.3K | 2.4K |
| 2018 | $1.2K | $113.73 | 10.93x | $1.1K | $519.0K | 6.2K | 2.5K |
| 2019 | $1.2K | $126.35 | 9.43x | $1.1K | $576.0K | 7.2K | 2.4K |
| 2020 | $1.2K | $96.72 | 12.46x | $1.1K | $552.0K | 7.3K | 2.5K |
| 2021 | $1.7K | $103.58 | 16.56x | $1.6K | $705.9K | 9.3K | 3.9K |
| 2022 | $1.7K | $98.40 | 16.87x | $1.6K | $765.9K | 10.5K | 4.5K |
| 2023 | $1.8K | $101.18 | 18.13x | $1.7K | $740.7K | 9.9K | 4.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 41.1K | $2.6M | $62.28 | 6.32x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 6.0K | $688.2K | $115.59 | 4.42x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 4.2K | $421.7K | $100.23 | 2.52x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 3.1K | $277.5K | $88.76 | 4.07x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.8K | $250.5K | $139.38 | 3.18x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 2.9K | $229.8K | $79.20 | 37.44x |
| 45380 | Biopsy of large bowel using an endoscope | 1.7K | $207.3K | $124.41 | 26.50x |
| 45385 | Removal of polyps or growths of large bowel using an endoscope | 588 | $123.4K | $209.92 | 17.63x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 675 | $114.5K | $169.64 | 3.26x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 889 | $113.5K | $127.64 | 2.37x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 489 | $86.3K | $176.40 | 2.25x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 370 | $69.0K | $186.59 | 3.22x |
| 43246 | Insertion of stomach tube using an endoscope | 381 | $63.1K | $165.60 | 15.10x |
| 43255 | Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope | 354 | $58.1K | $164.14 | 19.18x |
| 45378 | Diagnostic examination of large bowel using an endoscope | 372 | $57.6K | $154.73 | 18.06x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 532 | $38.5K | $72.45 | 2.09x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 1.0K | $34.1K | $32.47 | 6.78x |
| 46600 | Diagnostic examination of the anus using an endoscope | 330 | $30.3K | $91.82 | 2.18x |
| 43235 | Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope | 307 | $26.7K | $86.99 | 24.21x |
| 88342 | Tissue or cell analysis by immunologic technique | 820 | $24.7K | $30.18 | 7.30x |
This provider submits charges 8.36 times higher than what Medicare actually pays.
A markup ratio of 8.36x means for every $100 Medicare pays, this provider initially charges $836. 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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