This provider's $5.2M in total Medicare payments ranks in the 99th percentile of Orthopedic Surgery providers nationally.
Their average markup ratio of 6.25x is significantly above the specialty median of 4.7x.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 60% in 2017
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 | $1.4K | $161.67 | 8.66x | $1.2K | $458.0K | 6.4K | 4.0K |
| 2015 | $1.3K | $155.08 | 8.38x | $1.1K | $465.0K | 5.6K | 4.2K |
| 2016 | $1.4K | $165.02 | 8.35x | $1.2K | $408.8K | 5.1K | 3.9K |
| 2017 | $1.5K | $257.84 | 5.91x | $1.3K | $655.1K | 5.7K | 4.4K |
| 2018 | $1.4K | $190.80 | 7.36x | $1.2K | $477.6K | 5.6K | 4.3K |
| 2019 | $1.5K | $209.05 | 7.41x | $1.3K | $476.7K | 5.7K | 4.3K |
| 2020 | $1.6K | $206.99 | 7.97x | $1.4K | $389.6K | 3.6K | 3.0K |
| 2021 | $2.1K | $271.31 | 7.77x | $1.8K | $551.4K | 4.6K | 3.9K |
| 2022 | $2.3K | $287.83 | 8.00x | $2.0K | $660.4K | 5.2K | 4.4K |
| 2023 | $2.3K | $299.62 | 7.83x | $2.0K | $661.9K | 5.4K | 4.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 23472 | Prosthetic repair of shoulder joint | 1.1K | $1.4M | $1.3K | 6.12x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 7.2K | $655.8K | $90.65 | 3.74x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 4.0K | $511.6K | $126.69 | 4.25x |
| 29827 | Repair of shoulder rotator cuff using an endoscope | 527 | $502.6K | $953.68 | 6.65x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 6.8K | $383.6K | $56.67 | 5.22x |
| 23430 | Anchoring of biceps tendon | 1.0K | $352.0K | $344.06 | 10.39x |
| 73030 | X-ray of shoulder, minimum of 2 views | 11.8K | $311.0K | $26.33 | 3.63x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 5.0K | $284.5K | $57.19 | 3.84x |
| 29823 | Extensive removal of shoulder joint tissue using an endoscope | 701 | $166.9K | $238.08 | 17.55x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.1K | $126.5K | $119.37 | 4.08x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.6K | $124.6K | $80.31 | 4.81x |
| 29826 | Shaving of shoulder bone using an endoscope | 626 | $101.1K | $161.50 | 20.09x |
| 20985 | Computer-assisted surgical navigational procedure for bone procedures | 376 | $48.0K | $127.56 | 7.88x |
| 29828 | Release of shoulder biceps tendon using an endoscope | 106 | $46.2K | $435.77 | 13.63x |
| 23474 | Revision of total shoulder repair, total shoulder | 26 | $39.3K | $1.5K | 5.95x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 222 | $37.7K | $169.90 | 4.15x |
| 97110 | Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 1.2K | $22.8K | $19.49 | 5.69x |
| 97140 | Manual (physical) therapy techniques to 1 or more regions, each 15 minutes | 641 | $10.9K | $16.95 | 3.54x |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 6.2K | $7.8K | $1.26 | 19.15x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 82 | $7.2K | $87.84 | 3.14x |
This provider submits charges 6.25 times higher than what Medicare actually pays.
A markup ratio of 6.25x means for every $100 Medicare pays, this provider initially charges $625. 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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