⚠️ This provider averages 1.4K services per working day — physically unusual for an individual practitioner
Based on 3.5M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $50.8M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 1.4K services per working day raises questions about billing patterns.
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 | $33.26 | $15.74 | 2.11x | $17.52 | $5.2M | 333.0K | 67 |
| 2015 | $30.39 | $15.40 | 1.97x | $14.99 | $6.2M | 405.4K | 65 |
| 2016 | $27.60 | $14.63 | 1.89x | $12.97 | $4.8M | 328.1K | 64 |
| 2017 | $26.60 | $15.63 | 1.70x | $10.97 | $5.1M | 325.3K | 61 |
| 2018 | $27.88 | $16.06 | 1.74x | $11.82 | $6.0M | 373.0K | 57 |
| 2019 | $28.55 | $15.50 | 1.84x | $13.05 | $5.7M | 370.2K | 59 |
| 2020 | $28.92 | $14.93 | 1.94x | $13.99 | $5.3M | 355.1K | 57 |
| 2021 | $27.99 | $13.67 | 2.05x | $14.32 | $4.3M | 315.5K | 55 |
| 2022 | $25.08 | $11.54 | 2.17x | $13.54 | $4.2M | 367.4K | 49 |
| 2023 | $25.52 | $11.62 | 2.20x | $13.90 | $3.8M | 330.3K | 43 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 206.7K | $10.7M | $51.65 | 2.13x |
| 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) | 153.8K | $5.5M | $36.01 | 1.70x |
| J3262 | Injection, tocilizumab, 1 mg | 1.3M | $4.9M | $3.69 | 1.72x |
| J0897 | Injection, denosumab, 1 mg | 312.1K | $4.4M | $14.16 | 1.63x |
| 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) | 829.4K | $4.4M | $5.33 | 1.88x |
| J9312 | Injection, rituximab, 10 mg | 54.4K | $3.8M | $69.44 | 1.73x |
| J9310 | Injection, rituximab, 100 mg | 5.4K | $3.2M | $603.17 | 1.51x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 167.7K | $2.8M | $16.43 | 1.95x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 26.0K | $1.9M | $74.12 | 1.93x |
| J0490 | Injection, belimumab, 10 mg | 57.5K | $1.9M | $33.25 | 1.65x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 12.1K | $1.2M | $97.13 | 2.42x |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | 32.9K | $966.4K | $29.37 | 2.89x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 6.5K | $323.7K | $49.98 | 1.89x |
| 80053 | Blood test, comprehensive group of blood chemicals | 25.8K | $312.4K | $12.09 | 2.32x |
| 82306 | Vitamin d-3 level | 8.1K | $285.2K | $35.20 | 1.73x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 36.8K | $283.4K | $7.71 | 1.56x |
| 76881 | Complete ultrasound scan of joint | 4.2K | $277.9K | $66.34 | 2.91x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 11.1K | $231.3K | $20.89 | 5.75x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 23.9K | $216.3K | $9.06 | 1.99x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.7K | $189.8K | $108.54 | 1.79x |
This provider submits charges 1.95 times higher than what Medicare actually pays.
A markup ratio of 1.95x means for every $100 Medicare pays, this provider initially charges $195. This is lower 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 AL for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Edmund Lacour, M.D. | Dothan, AL | $39.0M | ✓ 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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