⚠️ This provider averages 541 services per working day — physically unusual for an individual practitioner
Based on 1.4M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $23.9M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 541 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 181% from 2014 to 2023.
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 | $87.48 | $35.78 | 2.44x | $51.70 | $1.3M | 36.0K | 43 |
| 2015 | $58.68 | $22.87 | 2.57x | $35.81 | $1.3M | 57.3K | 41 |
| 2016 | $39.83 | $15.52 | 2.57x | $24.31 | $1.9M | 123.0K | 38 |
| 2017 | $56.46 | $21.66 | 2.61x | $34.80 | $2.4M | 109.7K | 45 |
| 2018 | $62.00 | $23.54 | 2.63x | $38.46 | $2.6M | 111.5K | 45 |
| 2019 | $53.31 | $20.11 | 2.65x | $33.20 | $2.5M | 123.2K | 40 |
| 2020 | $56.38 | $20.33 | 2.77x | $36.05 | $2.5M | 121.5K | 44 |
| 2021 | $58.77 | $19.21 | 3.06x | $39.56 | $2.7M | 142.9K | 42 |
| 2022 | $48.30 | $13.03 | 3.71x | $35.27 | $3.1M | 238.1K | 49 |
| 2023 | $49.75 | $12.49 | 3.98x | $37.26 | $3.6M | 290.1K | 44 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0129 | Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 186.1K | $6.7M | $36.27 | 3.03x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 88.0K | $4.5M | $50.98 | 2.98x |
| J0717 | Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 570.0K | $3.0M | $5.27 | 3.15x |
| J9312 | Injection, rituximab, 10 mg | 21.2K | $1.5M | $69.84 | 3.11x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 111.9K | $1.4M | $12.65 | 3.82x |
| J9310 | Injection, rituximab, 100 mg | 1.8K | $1.1M | $637.13 | 2.52x |
| J0897 | Injection, denosumab, 1 mg | 59.2K | $902.2K | $15.25 | 2.49x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 9.9K | $785.0K | $79.07 | 2.89x |
| J3262 | Injection, tocilizumab, 1 mg | 167.7K | $721.1K | $4.30 | 3.65x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 6.0K | $611.9K | $102.58 | 3.04x |
| 86235 | Measurement of antibody for assessment of autoimmune disorder, any method | 17.4K | $353.8K | $20.29 | 2.29x |
| J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose | 2.5K | $268.2K | $108.61 | 2.80x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 3.7K | $210.2K | $57.42 | 3.00x |
| 20611 | Aspiration and/or injection of fluid large joint using ultrasound guidance | 2.1K | $178.9K | $83.97 | 3.18x |
| 80053 | Blood test, comprehensive group of blood chemicals | 11.1K | $127.6K | $11.48 | 2.34x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.1K | $127.5K | $118.69 | 3.53x |
| 82306 | Vitamin d-3 level | 3.5K | $111.6K | $32.02 | 2.27x |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | 2.4K | $104.4K | $44.41 | 3.14x |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | 3.4K | $100.4K | $29.98 | 3.97x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 10.8K | $93.4K | $8.68 | 2.33x |
This provider submits charges 3.02 times higher than what Medicare actually pays.
A markup ratio of 3.02x means for every $100 Medicare pays, this provider initially charges $302. This is higher than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
Other Rheumatology providers in TX for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Constantine Saadeh, M.D. | Amarillo, TX | $39.3M | ✓ Clear |
| Grace Makhlouf, M.D. | Sugar Land, TX | $34.2M | ✓ Clear |
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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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