This provider's $6.4M 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 | $618.27 | $201.62 | 3.07x | $416.65 | $551.2K | 5.8K | 4.5K |
| 2015 | $654.01 | $202.98 | 3.22x | $451.03 | $564.3K | 6.1K | 4.7K |
| 2016 | $664.41 | $210.54 | 3.16x | $453.87 | $572.3K | 6.5K | 5.1K |
| 2017 | $651.42 | $236.43 | 2.76x | $414.99 | $742.5K | 7.2K | 5.7K |
| 2018 | $632.30 | $201.47 | 3.14x | $430.83 | $653.8K | 7.6K | 6.1K |
| 2019 | $693.75 | $222.33 | 3.12x | $471.42 | $727.0K | 7.7K | 6.3K |
| 2020 | $773.50 | $252.65 | 3.06x | $520.85 | $662.6K | 7.5K | 6.0K |
| 2021 | $715.57 | $210.89 | 3.39x | $504.68 | $637.7K | 7.2K | 5.8K |
| 2022 | $576.98 | $162.79 | 3.54x | $414.19 | $650.3K | 7.2K | 5.9K |
| 2023 | $584.57 | $159.80 | 3.66x | $424.77 | $643.3K | 6.7K | 5.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 23472 | Prosthetic repair of shoulder joint | 1.4K | $1.7M | $1.2K | 2.53x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 18.5K | $1.0M | $56.60 | 2.76x |
| 29827 | Repair of shoulder rotator cuff using an endoscope | 774 | $688.4K | $889.37 | 2.55x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 7.2K | $534.4K | $74.54 | 2.96x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 8.3K | $409.4K | $49.33 | 2.88x |
| 24301 | Relocation of muscle or tendon of upper arm or elbow | 1.3K | $408.4K | $315.11 | 4.92x |
| 73030 | X-ray of shoulder, minimum of 2 views | 12.0K | $274.9K | $22.90 | 2.90x |
| 73221 | MRI scan of arm joint | 1.9K | $219.3K | $116.41 | 4.00x |
| 23405 | Incision of shoulder tendon | 669 | $178.2K | $266.39 | 4.95x |
| 27245 | Surgical treatment of broken thigh bone | 167 | $173.5K | $1.0K | 2.49x |
| 27236 | Open treatment of broken thigh bone with insertion of hardware or prosthetic replacement | 154 | $155.2K | $1.0K | 2.50x |
| 29826 | Shaving of shoulder bone using an endoscope | 785 | $117.3K | $149.38 | 6.69x |
| 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 | 1.9K | $82.7K | $42.42 | 2.10x |
| J1040 | Injection, methylprednisolone acetate, 80 mg | 8.5K | $66.6K | $7.79 | 2.67x |
| 29823 | Extensive removal of shoulder joint tissue using an endoscope | 387 | $53.0K | $137.06 | 9.70x |
| 23430 | Anchoring of biceps tendon | 140 | $42.9K | $306.29 | 5.12x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 328 | $26.2K | $79.98 | 2.60x |
| 73020 | X-ray of shoulder, 1 view | 1.5K | $25.9K | $16.98 | 2.89x |
| 72141 | MRI scan of upper spinal canal | 201 | $20.8K | $103.70 | 4.24x |
| 23600 | Closed treatment of upper arm fracture | 66 | $17.5K | $265.42 | 2.56x |
This provider submits charges 3.08 times higher than what Medicare actually pays.
A markup ratio of 3.08x means for every $100 Medicare pays, this provider initially charges $308. 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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