This provider's $6.0M 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 | $823.98 | $195.67 | 4.21x | $628.31 | $747.5K | 11.1K | 5.6K |
| 2015 | $944.42 | $229.02 | 4.12x | $715.40 | $693.1K | 10.4K | 5.1K |
| 2016 | $776.74 | $170.36 | 4.56x | $606.38 | $584.5K | 9.6K | 4.5K |
| 2017 | $947.04 | $231.78 | 4.09x | $715.26 | $588.8K | 9.5K | 4.4K |
| 2018 | $672.86 | $161.89 | 4.16x | $510.97 | $516.0K | 9.2K | 4.3K |
| 2019 | $709.67 | $177.39 | 4.00x | $532.28 | $495.8K | 9.4K | 3.9K |
| 2020 | $687.85 | $181.68 | 3.79x | $506.17 | $530.3K | 10.0K | 4.1K |
| 2021 | $719.31 | $181.16 | 3.97x | $538.15 | $590.0K | 10.2K | 4.3K |
| 2022 | $710.73 | $190.08 | 3.74x | $520.65 | $606.5K | 9.9K | 4.2K |
| 2023 | $658.85 | $174.50 | 3.78x | $484.35 | $614.4K | 10.4K | 4.4K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 11.7K | $999.7K | $85.35 | 2.13x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 14.7K | $853.7K | $58.05 | 2.13x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 16.6K | $801.5K | $48.36 | 2.07x |
| 27130 | Replacement of thigh bone and hip joint prosthesis | 335 | $371.3K | $1.1K | 3.61x |
| 23412 | Repair of torn tendons of shoulder, open procedure | 488 | $340.5K | $697.67 | 3.58x |
| 27447 | Repair of knee joint | 239 | $269.3K | $1.1K | 3.79x |
| 23472 | Prosthetic repair of shoulder joint | 206 | $242.7K | $1.2K | 3.39x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.3K | $173.4K | $130.67 | 2.39x |
| 29879 | Repair of knee joint using an endoscope | 299 | $162.2K | $542.37 | 4.29x |
| 73565 | X-ray of both knees, standing, front to back view | 4.8K | $136.0K | $28.45 | 2.99x |
| 29824 | Partial removal of collar bone at shoulder using an endoscope | 486 | $133.7K | $275.04 | 8.72x |
| 73560 | X-ray of knee, 1 or 2 views | 5.0K | $123.1K | $24.75 | 2.86x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.3K | $103.4K | $77.88 | 2.30x |
| 73030 | X-ray of shoulder, minimum of 2 views | 3.9K | $93.6K | $24.10 | 2.50x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 722 | $88.0K | $121.87 | 2.33x |
| 73502 | X-ray of hip with pelvis, 2-3 views | 2.5K | $83.3K | $33.49 | 3.88x |
| 29826 | Shaving of shoulder bone using an endoscope | 485 | $71.1K | $146.59 | 11.27x |
| 27487 | Revision of lower thigh bone and both shin bone components of total knee joint prosthesis | 48 | $68.1K | $1.4K | 3.52x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 585 | $63.7K | $108.89 | 2.06x |
| J1030 | Injection, methylprednisolone acetate, 40 mg | 12.6K | $53.8K | $4.26 | 4.69x |
This provider submits charges 3.06 times higher than what Medicare actually pays.
A markup ratio of 3.06x means for every $100 Medicare pays, this provider initially charges $306. 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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