This provider's $5.4M in total Medicare payments ranks in the 99th percentile of Orthopedic Surgery providers nationally.
Their average markup ratio of 7.11x is significantly above the specialty median of 4.7x.
Medicare payments to this provider grew 64% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 86% in 2015
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 | $1.1K | $242.28 | 4.73x | $903.54 | $292.6K | 2.6K | 2.0K |
| 2015 | $1.2K | $251.50 | 4.96x | $995.09 | $545.1K | 4.8K | 3.6K |
| 2016 | $1.7K | $265.97 | 6.34x | $1.4K | $495.6K | 4.9K | 3.6K |
| 2017 | $2.6K | $266.32 | 9.60x | $2.3K | $575.9K | 5.5K | 3.9K |
| 2018 | $2.8K | $282.57 | 9.81x | $2.5K | $634.4K | 5.8K | 3.8K |
| 2019 | $2.7K | $282.38 | 9.42x | $2.4K | $683.9K | 6.1K | 4.1K |
| 2020 | $2.0K | $223.19 | 8.75x | $1.7K | $589.5K | 7.3K | 3.7K |
| 2021 | $1.8K | $219.44 | 8.40x | $1.6K | $604.8K | 7.2K | 3.5K |
| 2022 | $1.4K | $192.33 | 7.24x | $1.2K | $504.7K | 7.4K | 3.8K |
| 2023 | $1.5K | $177.05 | 8.49x | $1.3K | $479.8K | 7.6K | 3.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 11.9K | $1.1M | $90.68 | 7.23x |
| J7326 | Hyaluronan or derivative, gel-one, for intra-articular injection, per dose | 1.0K | $740.3K | $706.41 | 4.51x |
| 23472 | Prosthetic repair of shoulder joint | 324 | $410.5K | $1.3K | 6.65x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 7.4K | $407.9K | $55.27 | 6.74x |
| 27245 | Surgical treatment of broken thigh bone | 286 | $306.6K | $1.1K | 6.49x |
| 27236 | Open treatment of broken thigh bone with insertion of hardware or prosthetic replacement | 226 | $236.0K | $1.0K | 6.26x |
| 27447 | Repair of knee joint | 192 | $227.1K | $1.2K | 7.22x |
| 29827 | Repair of shoulder rotator cuff using an endoscope | 225 | $205.2K | $911.87 | 6.27x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 2.4K | $186.1K | $79.09 | 6.92x |
| 27130 | Replacement of thigh bone and hip joint prosthesis | 108 | $127.5K | $1.2K | 6.79x |
| 29879 | Repair of knee joint using an endoscope | 171 | $97.2K | $568.16 | 6.89x |
| 99204 | New patient outpatient visit, total time 45-59 minutes | 697 | $85.6K | $122.83 | 8.50x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 1.5K | $84.8K | $56.63 | 6.33x |
| 73030 | X-ray of shoulder, minimum of 2 views | 3.1K | $75.4K | $24.21 | 7.32x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 679 | $75.3K | $110.87 | 7.14x |
| 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 imple | 1.3K | $58.5K | $43.76 | 6.67x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 362 | $58.4K | $161.26 | 4.00x |
| 73560 | X-ray of knee, 1 or 2 views | 2.2K | $56.3K | $25.31 | 7.36x |
| 97110 | Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 2.8K | $55.4K | $19.59 | 9.74x |
| 29828 | Release of shoulder biceps tendon using an endoscope | 131 | $51.0K | $389.25 | 14.79x |
This provider submits charges 7.11 times higher than what Medicare actually pays.
A markup ratio of 7.11x means for every $100 Medicare pays, this provider initially charges $711. 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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