This provider's $4.9M in total Medicare payments ranks in the 99th percentile of Orthopedic Surgery 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 | $604.35 | $211.18 | 2.86x | $393.17 | $477.5K | 5.4K | 4.1K |
| 2015 | $498.16 | $176.00 | 2.83x | $322.16 | $466.1K | 4.8K | 3.7K |
| 2016 | $628.58 | $222.82 | 2.82x | $405.76 | $436.5K | 4.4K | 3.4K |
| 2017 | $717.92 | $233.37 | 3.08x | $484.55 | $375.1K | 3.5K | 2.7K |
| 2018 | $693.18 | $239.55 | 2.89x | $453.63 | $459.0K | 4.4K | 3.2K |
| 2019 | $758.70 | $247.97 | 3.06x | $510.73 | $548.3K | 4.5K | 3.2K |
| 2020 | $694.49 | $222.76 | 3.12x | $471.73 | $445.5K | 3.8K | 2.8K |
| 2021 | $817.09 | $250.39 | 3.26x | $566.70 | $579.4K | 4.3K | 3.2K |
| 2022 | $740.51 | $235.39 | 3.15x | $505.12 | $548.4K | 4.3K | 3.2K |
| 2023 | $779.68 | $230.97 | 3.38x | $548.71 | $568.5K | 4.5K | 3.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 23472 | Prosthetic repair of shoulder joint | 925 | $1.2M | $1.3K | 2.54x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 12.3K | $1.1M | $87.08 | 2.73x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 5.5K | $663.6K | $120.66 | 2.89x |
| 29827 | Repair of shoulder rotator cuff using an endoscope | 545 | $506.8K | $929.91 | 2.54x |
| 20611 | Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance | 4.0K | $305.5K | $77.08 | 2.62x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.2K | $257.0K | $60.81 | 2.72x |
| J7324 | Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose | 1.4K | $212.2K | $152.25 | 2.66x |
| 76881 | Ultrasound of leg or arm | 2.2K | $171.0K | $77.08 | 2.65x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 3.1K | $158.0K | $51.10 | 2.59x |
| 29826 | Shaving of shoulder bone using an endoscope | 610 | $95.5K | $156.52 | 3.57x |
| 29823 | Extensive removal of shoulder joint tissue using an endoscope | 483 | $86.5K | $179.19 | 7.58x |
| 76942 | Ultrasonic guidance imaging supervision and interpretation for insertion of needle | 832 | $48.5K | $58.30 | 3.52x |
| 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 | 811 | $35.5K | $43.74 | 2.53x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 360 | $25.5K | $70.91 | 3.35x |
| J1030 | Injection, methylprednisolone acetate, 40 mg | 5.8K | $24.3K | $4.18 | 2.44x |
| 23430 | Anchoring of biceps tendon | 57 | $21.2K | $372.15 | 4.43x |
| 20680 | Removal of deep bone implant | 45 | $9.1K | $201.78 | 6.51x |
| J7322 | Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg | 252 | $6.2K | $24.56 | 1.30x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 159 | $5.5K | $34.71 | 2.64x |
| 29880 | Removal of both knee cartilages using an endoscope | 11 | $5.2K | $474.28 | 2.64x |
This provider submits charges 2.8 times higher than what Medicare actually pays.
A markup ratio of 2.8x means for every $100 Medicare pays, this provider initially charges $280. 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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