This provider's $3.3M in total Medicare payments ranks in the 98th percentile of Orthopedic Surgery providers nationally.
Their average markup ratio of 5.65x 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 | $1.6K | $254.26 | 6.10x | $1.3K | $259.0K | 2.7K | 2.4K |
| 2015 | $1.4K | $238.61 | 6.00x | $1.2K | $258.8K | 2.4K | 2.1K |
| 2016 | $1.5K | $251.94 | 5.99x | $1.3K | $281.2K | 2.6K | 2.3K |
| 2017 | $1.5K | $243.52 | 6.21x | $1.3K | $306.1K | 2.6K | 2.3K |
| 2018 | $1.9K | $333.47 | 5.74x | $1.6K | $334.2K | 2.2K | 1.9K |
| 2019 | $1.7K | $301.19 | 5.67x | $1.4K | $368.4K | 2.0K | 1.8K |
| 2020 | $1.2K | $214.54 | 5.78x | $1.0K | $350.3K | 1.9K | 1.8K |
| 2021 | $1.5K | $244.83 | 6.00x | $1.2K | $386.4K | 2.0K | 1.8K |
| 2022 | $1.5K | $248.46 | 6.17x | $1.3K | $398.9K | 1.7K | 1.6K |
| 2023 | $1.1K | $182.45 | 6.30x | $967.09 | $359.0K | 2.2K | 1.7K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 23472 | Prosthetic repair of shoulder joint | 1.1K | $1.2M | $1.1K | 4.53x |
| 29827 | Repair of shoulder rotator cuff using an endoscope | 777 | $630.6K | $811.63 | 4.46x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 3.4K | $269.5K | $78.79 | 3.32x |
| 29828 | Release of shoulder biceps tendon using an endoscope | 516 | $184.5K | $357.60 | 8.50x |
| 23395 | Relocation of muscle of shoulder or upper arm | 312 | $151.0K | $483.92 | 8.80x |
| 20611 | Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance | 1.7K | $113.7K | $67.31 | 11.54x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.0K | $109.6K | $53.81 | 4.26x |
| 29826 | Shaving of shoulder bone using an endoscope | 784 | $105.9K | $135.02 | 16.35x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.4K | $101.0K | $73.75 | 3.48x |
| 73030 | X-ray of shoulder, minimum of 2 views | 4.5K | $97.7K | $21.49 | 3.70x |
| 23474 | Revision of total shoulder repair | 57 | $73.4K | $1.3K | 4.46x |
| 73221 | MRI scan of arm joint | 603 | $71.2K | $118.00 | 9.08x |
| 23430 | Anchoring of biceps tendon | 148 | $42.9K | $289.82 | 8.45x |
| 29823 | Extensive removal of shoulder joint tissue using an endoscope | 237 | $40.9K | $172.39 | 12.01x |
| 99204 | New patient outpatient visit, total time 45-59 minutes | 160 | $19.4K | $120.97 | 3.47x |
| 23600 | Closed treatment of upper arm fracture | 74 | $18.2K | $245.86 | 4.20x |
| 99457 | Remote physiologic monitoring treatment management services, health care professional time in a calendar month requiring interactive communication with the patient/caregiver; first 20 minutes | 420 | $15.9K | $37.92 | 4.08x |
| 76942 | Ultrasonic guidance imaging supervision and interpretation for insertion of needle | 281 | $15.2K | $54.06 | 9.35x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 288 | $13.5K | $46.84 | 5.92x |
| J1040 | Injection, methylprednisolone acetate, 80 mg | 1.8K | $12.6K | $6.99 | 2.84x |
This provider submits charges 5.65 times higher than what Medicare actually pays.
A markup ratio of 5.65x means for every $100 Medicare pays, this provider initially charges $565. 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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