This provider's $4.0M in total Medicare payments ranks in the 99th percentile of Gastroenterology providers nationally.
Medicare payments to this provider grew 56% 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 | $663.75 | $134.36 | 4.94x | $529.39 | $343.0K | 3.6K | 2.8K |
| 2015 | $741.90 | $134.86 | 5.50x | $607.04 | $327.7K | 3.5K | 2.9K |
| 2016 | $744.69 | $125.46 | 5.94x | $619.23 | $328.5K | 3.7K | 3.0K |
| 2017 | $792.00 | $130.45 | 6.07x | $661.55 | $346.9K | 3.8K | 3.1K |
| 2018 | $750.43 | $120.98 | 6.20x | $629.45 | $387.3K | 4.4K | 3.6K |
| 2019 | $709.64 | $132.95 | 5.34x | $576.69 | $432.0K | 4.5K | 3.7K |
| 2020 | $559.57 | $119.24 | 4.69x | $440.33 | $381.1K | 4.0K | 3.3K |
| 2021 | $698.01 | $123.73 | 5.64x | $574.28 | $457.5K | 4.7K | 3.8K |
| 2022 | $681.36 | $129.04 | 5.28x | $552.32 | $506.3K | 5.3K | 4.1K |
| 2023 | $685.28 | $125.71 | 5.45x | $559.57 | $534.8K | 5.7K | 4.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 11.4K | $737.1K | $64.48 | 1.82x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 7.0K | $603.0K | $86.50 | 3.25x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 7.8K | $478.2K | $61.60 | 1.90x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 3.9K | $440.1K | $113.21 | 1.86x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 4.6K | $381.9K | $82.29 | 10.95x |
| 45385 | Removal of polyps or growths of large bowel using an endoscope | 1.7K | $374.8K | $220.44 | 6.80x |
| 45384 | Removal of polyps or growths in large bowel using an endoscope | 1.6K | $312.4K | $192.82 | 6.22x |
| 45378 | Diagnostic examination of large bowel using an endoscope | 1.8K | $287.2K | $162.36 | 6.64x |
| 45380 | Biopsy of large bowel using an endoscope | 795 | $148.8K | $187.12 | 6.68x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.0K | $106.9K | $104.43 | 2.73x |
| 43246 | Insertion of stomach tube using an endoscope | 401 | $69.3K | $172.89 | 6.94x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 526 | $40.3K | $76.62 | 1.56x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 193 | $17.9K | $92.64 | 2.02x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 100 | $15.9K | $159.09 | 1.53x |
| 43255 | Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope | 73 | $11.9K | $163.48 | 7.91x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 75 | $8.5K | $113.03 | 1.57x |
| 99441 | Physician telephone patient service, 5-10 minutes of medical discussion | 126 | $4.4K | $35.17 | 2.49x |
| 43235 | Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope | 31 | $3.3K | $105.09 | 7.61x |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 14 | $2.5K | $176.40 | 1.02x |
| 43760 | Change of stomach feeding, accessed through the skin | 16 | $643.68 | $40.23 | 18.92x |
This provider submits charges 4.36 times higher than what Medicare actually pays.
A markup ratio of 4.36x means for every $100 Medicare pays, this provider initially charges $436. 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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