This provider's $4.6M in total Medicare payments ranks in the 99th percentile of Orthopedic Surgery providers nationally.
Medicare payments to this provider grew 84% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 72% in 2023
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 | $1.0K | $281.14 | 3.66x | $747.71 | $378.8K | 4.1K | 3.0K |
| 2015 | $1.0K | $293.84 | 3.45x | $718.63 | $400.0K | 4.2K | 3.2K |
| 2016 | $1.1K | $278.82 | 3.77x | $772.44 | $444.8K | 4.2K | 3.2K |
| 2017 | $1.1K | $289.31 | 3.65x | $766.47 | $467.3K | 4.2K | 3.3K |
| 2018 | $1.0K | $299.82 | 3.47x | $741.71 | $459.2K | 4.4K | 3.5K |
| 2019 | $1.0K | $306.12 | 3.40x | $734.31 | $513.7K | 4.9K | 3.7K |
| 2020 | $1.0K | $242.74 | 4.18x | $771.23 | $415.9K | 4.1K | 3.1K |
| 2021 | $1.2K | $234.43 | 5.23x | $991.61 | $439.0K | 4.3K | 3.3K |
| 2022 | $1.7K | $319.03 | 5.24x | $1.4K | $405.1K | 3.4K | 2.7K |
| 2023 | $4.4K | $264.87 | 16.44x | $4.1K | $698.1K | 6.2K | 5.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 23472 | Prosthetic repair of shoulder joint | 1.6K | $2.1M | $1.3K | 4.55x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 9.1K | $394.8K | $43.43 | 2.85x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 4.4K | $312.7K | $70.73 | 3.74x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.8K | $293.4K | $104.66 | 3.80x |
| 29827 | Repair of shoulder rotator cuff using an endoscope | 314 | $284.7K | $906.82 | 4.16x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 4.7K | $197.8K | $42.08 | 5.26x |
| 23474 | Revision of total shoulder repair | 112 | $167.3K | $1.5K | 4.65x |
| 73030 | X-ray of shoulder, minimum of 2 views | 14.4K | $164.0K | $11.40 | 8.93x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 975 | $140.6K | $144.18 | 4.39x |
| 29823 | Extensive removal of shoulder joint tissue using an endoscope | 442 | $106.1K | $240.07 | 10.26x |
| 24301 | Relocation of muscle or tendon of upper arm or elbow | 210 | $68.3K | $325.29 | 6.46x |
| 29828 | Release of shoulder biceps tendon using an endoscope | 139 | $64.9K | $467.12 | 6.12x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 566 | $59.6K | $105.30 | 4.32x |
| 23585 | Open treatment of broken shoulder blade | 123 | $55.0K | $447.08 | 8.44x |
| G0180 | Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implem | 1.2K | $51.7K | $43.78 | 5.10x |
| 29826 | Shaving of shoulder bone using an endoscope | 272 | $42.3K | $155.56 | 13.20x |
| 23440 | Transplantation of biceps tendon | 64 | $34.2K | $533.91 | 2.99x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 351 | $25.0K | $71.20 | 6.02x |
| 20680 | Removal of deep bone implant | 127 | $24.0K | $189.20 | 10.08x |
| 73080 | X-ray of elbow, minimum of 3 views | 826 | $7.1K | $8.58 | 8.14x |
This provider submits charges 4.83 times higher than what Medicare actually pays.
A markup ratio of 4.83x means for every $100 Medicare pays, this provider initially charges $483. 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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