This provider's $7.9M 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 | $919.03 | $155.05 | 5.93x | $763.98 | $759.9K | 6.6K | 5.7K |
| 2015 | $687.72 | $165.46 | 4.16x | $522.26 | $953.9K | 10.0K | 8.3K |
| 2016 | $646.92 | $169.46 | 3.82x | $477.46 | $1.2M | 11.8K | 9.4K |
| 2017 | $610.81 | $148.57 | 4.11x | $462.24 | $959.0K | 10.7K | 8.7K |
| 2018 | $665.22 | $153.96 | 4.32x | $511.26 | $567.1K | 5.7K | 4.8K |
| 2019 | $761.70 | $164.98 | 4.62x | $596.72 | $658.4K | 6.3K | 5.2K |
| 2020 | $712.82 | $169.18 | 4.21x | $543.64 | $563.0K | 5.1K | 4.3K |
| 2021 | $706.07 | $172.70 | 4.09x | $533.37 | $763.4K | 6.6K | 5.3K |
| 2022 | $731.29 | $162.89 | 4.49x | $568.40 | $768.7K | 6.8K | 5.2K |
| 2023 | $686.79 | $147.75 | 4.65x | $539.04 | $788.1K | 6.9K | 5.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 45384 | Removal of polyps or growths in large bowel using an endoscope | 5.6K | $1.7M | $306.05 | 4.10x |
| 43249 | Balloon dilation of esophagus using an endoscope | 1.9K | $1.5M | $802.89 | 1.58x |
| 43239 | Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope | 4.9K | $842.5K | $171.44 | 5.85x |
| 46221 | Removal of hemorrhoid by rubber banding | 2.3K | $453.7K | $199.79 | 3.99x |
| 45382 | Control of bleeding in large bowel using an endoscope | 878 | $411.4K | $468.59 | 2.77x |
| 45385 | Removal of polyps or growths of large bowel using an endoscope | 3.2K | $400.1K | $126.44 | 10.62x |
| 45380 | Biopsy of large bowel using an endoscope | 4.7K | $374.6K | $78.91 | 15.07x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 4.6K | $368.2K | $79.93 | 1.50x |
| 74177 | CT scan of abdomen and pelvis with contrast | 1.3K | $295.5K | $226.79 | 3.64x |
| 91110 | Imaging of digestive tract done from the inside of the digestive tract | 357 | $223.8K | $626.75 | 3.51x |
| 88305 | Pathology examination of tissue using a microscope, intermediate complexity | 3.9K | $203.2K | $52.34 | 3.34x |
| 88313 | Special stained specimen slides to examine tissue including interpretation and report | 3.3K | $161.6K | $49.66 | 3.52x |
| 74176 | CT scan of abdomen and pelvis | 869 | $124.2K | $142.95 | 6.04x |
| 88312 | Special stained specimen slides to identify organisms including interpretation and report | 1.5K | $109.4K | $71.60 | 2.44x |
| 91035 | Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation | 276 | $94.7K | $342.99 | 4.73x |
| 43250 | Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope | 355 | $81.2K | $228.78 | 3.93x |
| 43251 | Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope | 280 | $76.0K | $271.60 | 3.96x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.4K | $71.5K | $52.06 | 1.63x |
| 74261 | Diagnostic CT scan of large bowel | 402 | $69.5K | $172.87 | 7.50x |
| 45378 | Diagnostic examination of large bowel using an endoscope | 271 | $44.2K | $162.98 | 7.79x |
This provider submits charges 4.49 times higher than what Medicare actually pays.
A markup ratio of 4.49x means for every $100 Medicare pays, this provider initially charges $449. 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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