This provider's $9.3M 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 | $601.91 | $197.08 | 3.05x | $404.83 | $845.3K | 10.0K | 5.9K |
| 2015 | $556.34 | $179.37 | 3.10x | $376.97 | $705.2K | 8.3K | 4.7K |
| 2016 | $556.11 | $170.35 | 3.26x | $385.76 | $706.7K | 8.6K | 4.5K |
| 2017 | $626.03 | $184.93 | 3.39x | $441.10 | $913.7K | 11.0K | 5.3K |
| 2018 | $702.51 | $194.59 | 3.61x | $507.92 | $1.0M | 12.1K | 6.4K |
| 2019 | $640.63 | $182.79 | 3.50x | $457.84 | $1.2M | 14.7K | 7.3K |
| 2020 | $661.85 | $197.89 | 3.34x | $463.96 | $931.7K | 12.3K | 6.0K |
| 2021 | $435.91 | $121.98 | 3.57x | $313.93 | $832.1K | 11.0K | 5.4K |
| 2022 | $678.94 | $192.05 | 3.54x | $486.89 | $1.0M | 13.7K | 5.6K |
| 2023 | $456.16 | $114.45 | 3.99x | $341.71 | $1.1M | 14.8K | 6.2K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 17.8K | $1.6M | $92.15 | 2.38x |
| 99309 | Subsequent nursing facility visit, typically 25 minutes per day | 15.2K | $1.2M | $77.48 | 2.07x |
| 99306 | Initial nursing facility visit, typically 45 minutes per day | 6.7K | $911.6K | $136.20 | 2.42x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 13.2K | $760.0K | $57.65 | 2.52x |
| 27447 | Repair of knee joint | 605 | $686.1K | $1.1K | 2.77x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 12.5K | $573.9K | $45.77 | 3.29x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.7K | $339.7K | $125.04 | 2.44x |
| 27335 | Removal of knee joint covering | 691 | $232.6K | $336.63 | 4.64x |
| 27435 | Incision of back portion of knee joint capsule | 606 | $211.7K | $349.35 | 4.87x |
| 27245 | Surgical treatment of broken thigh bone | 192 | $201.1K | $1.0K | 2.77x |
| 15002 | Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children) | 1.0K | $196.3K | $190.40 | 3.57x |
| 73562 | X-ray of knee, 3 views | 5.9K | $187.8K | $32.04 | 2.95x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.8K | $181.6K | $64.32 | 2.25x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.0K | $169.0K | $165.87 | 2.23x |
| 27130 | Replacement of thigh bone and hip joint prosthesis | 140 | $158.7K | $1.1K | 2.58x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.3K | $147.4K | $112.57 | 2.39x |
| 20926 | Tissue graft | 691 | $126.2K | $182.69 | 4.80x |
| 27054 | Removal of membrane covering hip joint | 403 | $120.6K | $299.29 | 4.60x |
| 97530 | Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes | 2.7K | $91.7K | $34.05 | 1.82x |
| J1040 | Injection, methylprednisolone acetate, 80 mg | 9.6K | $79.5K | $8.25 | 2.42x |
This provider submits charges 2.79 times higher than what Medicare actually pays.
A markup ratio of 2.79x means for every $100 Medicare pays, this provider initially charges $279. 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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