⚠️ This provider averages 927 services per working day — physically unusual for an individual practitioner
Based on 2.3M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $28.6M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 927 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 164% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 65% in 2017
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 | $40.09 | $14.14 | 2.84x | $25.95 | $1.2M | 86.3K | 33 |
| 2015 | $44.72 | $16.70 | 2.68x | $28.02 | $1.6M | 95.7K | 31 |
| 2016 | $34.96 | $13.29 | 2.63x | $21.67 | $1.9M | 145.9K | 37 |
| 2017 | $50.62 | $15.62 | 3.24x | $35.00 | $3.2M | 205.1K | 34 |
| 2018 | $49.86 | $15.99 | 3.12x | $33.87 | $3.4M | 214.7K | 40 |
| 2019 | $46.87 | $15.17 | 3.09x | $31.70 | $3.7M | 246.8K | 40 |
| 2020 | $44.68 | $13.07 | 3.42x | $31.61 | $3.4M | 256.7K | 37 |
| 2021 | $41.18 | $11.73 | 3.51x | $29.45 | $3.7M | 312.2K | 42 |
| 2022 | $41.24 | $9.11 | 4.53x | $32.13 | $3.3M | 358.7K | 38 |
| 2023 | $38.93 | $8.16 | 4.77x | $30.77 | $3.2M | 395.0K | 31 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 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) | 1.1M | $6.0M | $5.35 | 3.28x |
| 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) | 134.1K | $4.9M | $36.33 | 2.20x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 100.7K | $4.8M | $47.38 | 5.25x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 250.0K | $3.5M | $14.05 | 5.12x |
| J3262 | Injection, tocilizumab, 1 mg | 385.1K | $1.6M | $4.21 | 2.81x |
| J0897 | Injection, denosumab, 1 mg | 98.9K | $1.5M | $15.06 | 2.17x |
| J7325 | Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg | 108.9K | $1.0M | $9.28 | 1.93x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 8.2K | $728.4K | $88.80 | 2.16x |
| 76881 | Complete ultrasound scan of joint | 8.8K | $594.8K | $67.91 | 5.23x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 4.7K | $540.7K | $114.05 | 2.84x |
| J9312 | Injection, rituximab, 10 mg | 6.8K | $490.8K | $72.18 | 2.00x |
| J7327 | Hyaluronan or derivative, monovisc, for intra-articular injection, per dose | 642 | $449.7K | $700.43 | 2.06x |
| 99215 | Established patient outpatient visit, total time 40-54 minutes | 3.4K | $384.9K | $114.45 | 2.18x |
| 20611 | Aspiration and/or injection of fluid large joint using ultrasound guidance | 4.4K | $367.6K | $83.29 | 5.19x |
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 12.7K | $258.9K | $20.43 | 2.96x |
| J3304 | Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg | 15.1K | $215.7K | $14.25 | 1.75x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 3.6K | $213.3K | $59.17 | 2.29x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 2.6K | $158.4K | $61.99 | 2.51x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 868 | $111.7K | $128.73 | 2.22x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 1.6K | $94.8K | $60.75 | 5.20x |
This provider submits charges 3.49 times higher than what Medicare actually pays.
A markup ratio of 3.49x means for every $100 Medicare pays, this provider initially charges $349. 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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