This provider's $4.0M in total Medicare payments ranks in the 99th percentile of Gastroenterology providers nationally.
Medicare payments to this provider grew 88% 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 | $341.70 | $121.64 | 2.81x | $220.06 | $380.8K | 4.8K | 2.1K |
| 2015 | $341.74 | $117.40 | 2.91x | $224.34 | $310.8K | 4.1K | 1.7K |
| 2016 | $250.13 | $90.76 | 2.76x | $159.37 | $242.0K | 3.5K | 1.6K |
| 2017 | $299.92 | $110.94 | 2.70x | $188.98 | $347.1K | 4.6K | 2.0K |
| 2018 | $329.77 | $107.43 | 3.07x | $222.34 | $352.4K | 4.8K | 1.8K |
| 2019 | $310.16 | $114.90 | 2.70x | $195.26 | $349.3K | 4.2K | 1.8K |
| 2020 | $336.89 | $121.81 | 2.77x | $215.08 | $360.0K | 4.4K | 1.4K |
| 2021 | $332.39 | $119.90 | 2.77x | $212.49 | $423.1K | 5.2K | 1.5K |
| 2022 | $315.25 | $115.10 | 2.74x | $200.15 | $529.6K | 7.1K | 1.5K |
| 2023 | $309.06 | $113.53 | 2.72x | $195.53 | $714.6K | 9.3K | 1.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 30.7K | $1.9M | $62.03 | 2.35x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 3.8K | $431.6K | $113.94 | 1.71x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 2.3K | $378.5K | $165.52 | 1.94x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 4.2K | $244.5K | $57.71 | 3.01x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 2.3K | $213.1K | $91.93 | 2.09x |
| 43246 | Insertion of stomach tube using an endoscope | 803 | $148.2K | $184.59 | 1.89x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 1.2K | $136.4K | $111.99 | 4.69x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.9K | $109.5K | $56.66 | 2.33x |
| 45378 | Diagnostic examination of large bowel using an endoscope | 373 | $63.4K | $169.90 | 2.96x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 489 | $53.0K | $108.38 | 2.17x |
| 99239 | Hospital discharge day management, more than 30 minutes | 543 | $48.0K | $88.36 | 1.83x |
| 45385 | Removal of polyps or growths of large bowel using an endoscope | 196 | $45.0K | $229.69 | 2.99x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 1.3K | $39.8K | $30.11 | 2.03x |
| 43762 | Replacement of stomach stoma tube accessed through skin | 250 | $31.5K | $125.91 | 2.38x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 369 | $30.0K | $81.41 | 2.30x |
| 45380 | Biopsy of large bowel using an endoscope | 156 | $29.3K | $187.76 | 3.80x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 115 | $21.9K | $190.21 | 1.91x |
| 43235 | Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope | 180 | $19.4K | $107.55 | 3.81x |
| 45384 | Removal of polyps or growths in large bowel using an endoscope | 43 | $10.7K | $249.14 | 2.19x |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 88 | $10.3K | $116.88 | 1.28x |
This provider submits charges 2.37 times higher than what Medicare actually pays.
A markup ratio of 2.37x means for every $100 Medicare pays, this provider initially charges $237. 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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