This provider's $3.4M in total Medicare payments ranks in the 98th percentile of Orthopedic Surgery providers nationally.
Their average markup ratio of 5.27x is significantly above the specialty median of 4.7x.
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 | $1.2K | $190.93 | 6.51x | $1.1K | $336.5K | 2.4K | 2.1K |
| 2015 | $1.8K | $250.01 | 7.21x | $1.6K | $405.7K | 2.8K | 2.4K |
| 2016 | $1.8K | $261.89 | 7.05x | $1.6K | $441.2K | 3.2K | 2.7K |
| 2017 | $1.3K | $214.17 | 6.08x | $1.1K | $429.3K | 3.9K | 2.9K |
| 2018 | $1.3K | $242.73 | 5.16x | $1.0K | $377.8K | 3.0K | 2.6K |
| 2019 | $935.41 | $179.42 | 5.21x | $755.99 | $378.1K | 3.3K | 2.7K |
| 2020 | $980.25 | $186.33 | 5.26x | $793.92 | $236.6K | 2.1K | 1.7K |
| 2021 | $922.28 | $187.19 | 4.93x | $735.09 | $243.6K | 2.1K | 1.7K |
| 2022 | $1.1K | $230.13 | 4.77x | $866.94 | $273.3K | 2.2K | 1.8K |
| 2023 | $1.4K | $259.09 | 5.22x | $1.1K | $286.3K | 1.9K | 1.6K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 23472 | Prosthetic repair of shoulder joint | 1.1K | $1.4M | $1.2K | 4.50x |
| 29827 | Repair of shoulder rotator cuff using an endoscope | 302 | $266.2K | $881.60 | 3.80x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.3K | $194.4K | $58.07 | 2.99x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 2.3K | $182.5K | $78.49 | 3.53x |
| 73030 | X-ray of shoulder, minimum of 2 views | 7.3K | $165.0K | $22.64 | 4.74x |
| 23020 | Severing of shoulder tendon to repair contracture | 558 | $161.3K | $289.00 | 8.83x |
| 23430 | Anchoring of biceps tendon | 478 | $155.7K | $325.79 | 7.75x |
| 23474 | Revision of total shoulder repair | 97 | $142.7K | $1.5K | 4.33x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.3K | $113.6K | $87.26 | 2.83x |
| 20611 | Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance | 1.4K | $110.2K | $77.65 | 4.58x |
| 24400 | Incision to repair upper arm bone | 212 | $74.0K | $349.03 | 8.23x |
| 73010 | X-ray of shoulder blade | 3.3K | $73.5K | $22.01 | 4.62x |
| 29824 | Partial removal of collar bone at shoulder using an endoscope | 278 | $70.7K | $254.18 | 8.28x |
| 23440 | Transplantation of biceps tendon | 189 | $61.2K | $323.63 | 10.83x |
| 29823 | Extensive removal of shoulder joint tissue using an endoscope | 352 | $56.4K | $160.33 | 14.86x |
| 29826 | Shaving of shoulder bone using an endoscope | 358 | $53.4K | $149.08 | 11.82x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 708 | $23.9K | $33.82 | 3.34x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 173 | $20.9K | $120.86 | 3.37x |
| 20900 | Small bone graft harvest | 152 | $12.5K | $82.15 | 17.41x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 224 | $11.5K | $51.32 | 5.12x |
This provider submits charges 5.27 times higher than what Medicare actually pays.
A markup ratio of 5.27x means for every $100 Medicare pays, this provider initially charges $527. 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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