This provider's $4.5M in total Medicare payments ranks in the 99th percentile of Sports Medicine 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 | $1.2K | $209.68 | 5.71x | $987.75 | $376.7K | 3.6K | 3.0K |
| 2015 | $1.2K | $224.06 | 5.38x | $980.32 | $417.6K | 3.5K | 3.0K |
| 2016 | $1.3K | $276.33 | 4.75x | $1.0K | $434.9K | 3.2K | 2.7K |
| 2017 | $1.4K | $258.00 | 5.41x | $1.1K | $429.0K | 3.2K | 2.9K |
| 2018 | $1.5K | $278.22 | 5.37x | $1.2K | $471.5K | 3.1K | 2.8K |
| 2019 | $1.5K | $269.93 | 5.43x | $1.2K | $441.1K | 3.2K | 2.9K |
| 2020 | $1.4K | $298.40 | 4.70x | $1.1K | $538.8K | 4.2K | 3.7K |
| 2021 | $1.3K | $281.45 | 4.58x | $1.0K | $468.0K | 3.9K | 3.6K |
| 2022 | $1.3K | $247.74 | 5.26x | $1.1K | $467.3K | 3.3K | 3.0K |
| 2023 | $1.0K | $208.25 | 5.03x | $839.23 | $471.1K | 3.5K | 2.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 27447 | Repair of knee joint | 1.6K | $1.7M | $1.0K | 5.41x |
| 23472 | Prosthetic repair of shoulder joint | 411 | $456.3K | $1.1K | 3.87x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 5.8K | $456.0K | $78.68 | 3.20x |
| 27130 | Replacement of thigh bone and hip joint prosthesis | 407 | $415.4K | $1.0K | 5.61x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.8K | $265.6K | $54.85 | 2.98x |
| 29827 | Repair of shoulder rotator cuff using an endoscope | 287 | $234.4K | $816.56 | 4.07x |
| 20610 | Aspiration and/or injection of large joint or joint capsule | 4.6K | $217.3K | $47.59 | 4.30x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.8K | $203.4K | $111.77 | 3.43x |
| 73562 | X-ray of knee, 3 views | 3.1K | $85.4K | $27.50 | 5.46x |
| 73221 | MRI scan of arm joint | 625 | $71.6K | $114.57 | 8.54x |
| 29828 | Release of shoulder biceps tendon using an endoscope | 137 | $49.5K | $361.50 | 5.78x |
| J7326 | Hyaluronan or derivative, gel-one, for intra-articular injection, per dose | 52 | $42.6K | $819.09 | 1.63x |
| 29826 | Shaving of shoulder bone using an endoscope | 293 | $40.0K | $136.41 | 10.61x |
| 73721 | MRI scan of leg joint | 352 | $39.6K | $112.57 | 8.38x |
| 73030 | X-ray of shoulder, minimum of 2 views | 1.6K | $36.3K | $22.70 | 6.20x |
| 73502 | X-ray of hip with pelvis, 2-3 views | 994 | $31.6K | $31.81 | 3.13x |
| J7324 | Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose | 155 | $21.3K | $137.51 | 2.31x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 291 | $21.1K | $72.41 | 1.96x |
| 73560 | X-ray of knee, 1 or 2 views | 687 | $14.6K | $21.31 | 5.66x |
| 72148 | MRI scan of lower spinal canal | 148 | $14.1K | $95.38 | 8.53x |
This provider submits charges 4.79 times higher than what Medicare actually pays.
A markup ratio of 4.79x means for every $100 Medicare pays, this provider initially charges $479. 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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