This provider's $6.8M 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 | $1.1K | $341.56 | 3.19x | $748.89 | $637.6K | 7.0K | 5.6K |
| 2015 | $986.16 | $284.93 | 3.46x | $701.23 | $615.0K | 7.4K | 5.7K |
| 2016 | $819.03 | $236.10 | 3.47x | $582.93 | $628.0K | 6.6K | 5.2K |
| 2017 | $946.45 | $270.24 | 3.50x | $676.21 | $619.8K | 7.3K | 5.5K |
| 2018 | $1.1K | $313.00 | 3.63x | $822.93 | $735.7K | 7.5K | 5.7K |
| 2019 | $1.3K | $397.96 | 3.36x | $940.72 | $766.8K | 7.3K | 5.5K |
| 2020 | $1.2K | $361.96 | 3.25x | $813.43 | $587.6K | 6.2K | 4.6K |
| 2021 | $728.53 | $211.36 | 3.45x | $517.17 | $655.2K | 6.7K | 5.2K |
| 2022 | $965.78 | $282.05 | 3.42x | $683.73 | $723.5K | 6.6K | 4.9K |
| 2023 | $1.0K | $282.58 | 3.65x | $749.83 | $799.4K | 7.1K | 5.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 27447 | Repair of knee joint | 1.3K | $1.5M | $1.2K | 4.26x |
| 27130 | Replacement of thigh bone and hip joint prosthesis | 804 | $940.4K | $1.2K | 4.25x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 10.2K | $938.0K | $91.73 | 2.27x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 12.3K | $711.5K | $57.71 | 2.41x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 10.5K | $507.7K | $48.23 | 2.88x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 3.2K | $395.3K | $125.26 | 2.62x |
| 23472 | Prosthetic repair of shoulder joint | 305 | $386.7K | $1.3K | 2.56x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 2.7K | $206.9K | $78.02 | 2.71x |
| 73564 | X-ray of knee, 4 or more views | 4.7K | $153.8K | $32.56 | 2.58x |
| 27446 | Repair of knee joint | 128 | $132.6K | $1.0K | 2.75x |
| 27487 | Revision of lower thigh bone and both shin bone components of total knee joint prosthesis | 68 | $102.7K | $1.5K | 3.47x |
| 73502 | X-ray of hip with pelvis, 2-3 views | 2.9K | $96.8K | $33.45 | 2.56x |
| 29828 | Release of shoulder biceps tendon using an endoscope | 112 | $85.6K | $764.38 | 2.56x |
| 0055T | Musculoskeletal surgical navigational orthopedic operation using imaging guidance | 380 | $82.1K | $216.18 | 3.18x |
| 73030 | X-ray of shoulder, minimum of 2 views | 3.0K | $72.9K | $24.06 | 2.71x |
| 73562 | X-ray of knee, 3 views | 1.8K | $54.8K | $29.84 | 2.51x |
| 29880 | Removal of both knee cartilages using an endoscope | 116 | $51.3K | $441.99 | 4.50x |
| 27134 | Revision of thigh bone and hip joint prosthesis | 30 | $49.0K | $1.6K | 3.04x |
| 29823 | Extensive removal of shoulder joint tissue using an endoscope | 168 | $45.4K | $270.06 | 5.77x |
| 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 | 759 | $32.7K | $43.06 | 2.83x |
This provider submits charges 3.25 times higher than what Medicare actually pays.
A markup ratio of 3.25x means for every $100 Medicare pays, this provider initially charges $325. 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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