This provider's $5.7M 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.
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 | $517.09 | $142.27 | 3.63x | $374.82 | $641.9K | 6.8K | 6.0K |
| 2015 | $505.10 | $133.59 | 3.78x | $371.51 | $551.2K | 6.3K | 5.6K |
| 2016 | $520.00 | $134.78 | 3.86x | $385.22 | $583.1K | 7.0K | 6.1K |
| 2017 | $492.36 | $111.34 | 4.42x | $381.02 | $563.0K | 6.3K | 5.6K |
| 2018 | $498.28 | $123.10 | 4.05x | $375.18 | $530.3K | 5.6K | 5.0K |
| 2019 | $475.00 | $123.12 | 3.86x | $351.88 | $527.6K | 5.9K | 5.1K |
| 2020 | $468.21 | $117.44 | 3.99x | $350.77 | $567.1K | 7.4K | 6.4K |
| 2021 | $450.00 | $115.22 | 3.91x | $334.78 | $610.7K | 8.1K | 7.0K |
| 2022 | $479.13 | $117.80 | 4.07x | $361.33 | $573.6K | 7.1K | 6.4K |
| 2023 | $500.37 | $115.28 | 4.34x | $385.09 | $530.4K | 6.9K | 6.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 45385 | Removal of polyps or growths of large bowel using an endoscope | 3.2K | $674.6K | $207.94 | 3.94x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 7.9K | $557.5K | $70.99 | 7.75x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 4.7K | $516.0K | $108.85 | 3.67x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 13.8K | $493.4K | $35.68 | 2.94x |
| 91110 | Imaging of digestive tract done from the inside of the digestive tract | 690 | $450.7K | $653.15 | 2.30x |
| 45380 | Biopsy of large bowel using an endoscope | 2.9K | $366.7K | $126.31 | 5.54x |
| 45378 | Diagnostic examination of large bowel using an endoscope | 2.2K | $330.1K | $151.98 | 3.95x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 5.5K | $323.3K | $58.44 | 3.00x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.6K | $257.3K | $56.42 | 3.10x |
| 99202 | New patient office or other outpatient visit, typically 20 minutes | 4.6K | $250.5K | $54.29 | 3.32x |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 1.1K | $214.9K | $195.75 | 2.96x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.3K | $211.2K | $161.73 | 3.06x |
| 43248 | Insertion of guide wire with dilation of esophagus using an endoscope | 1.5K | $188.9K | $123.70 | 4.04x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.6K | $130.6K | $79.61 | 3.27x |
| 88312 | Special stained specimen slides to identify organisms including interpretation and report | 1.7K | $107.4K | $64.95 | 1.97x |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 470 | $94.2K | $200.42 | 2.89x |
| 88313 | Special stained specimen slides to examine tissue including interpretation and report | 1.6K | $85.8K | $52.27 | 2.68x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 2.4K | $76.1K | $32.21 | 4.66x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 2.5K | $64.6K | $25.88 | 7.92x |
| 43235 | Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope | 524 | $48.5K | $92.62 | 3.78x |
This provider submits charges 4 times higher than what Medicare actually pays.
A markup ratio of 4x means for every $100 Medicare pays, this provider initially charges $400. 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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