⚠️ This provider averages 484 services per working day — physically unusual for an individual practitioner
Based on 1.2M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $17.1M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 484 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 811% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 71% 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 | $46.79 | $26.36 | 1.78x | $20.43 | $382.1K | 14.5K | 15 |
| 2015 | $46.42 | $26.32 | 1.76x | $20.10 | $619.2K | 23.5K | 15 |
| 2016 | $47.34 | $27.34 | 1.73x | $20.00 | $791.0K | 28.9K | 17 |
| 2017 | $26.92 | $16.54 | 1.63x | $10.38 | $1.4M | 81.9K | 16 |
| 2018 | $30.33 | $18.10 | 1.68x | $12.23 | $1.6M | 85.9K | 15 |
| 2019 | $28.10 | $16.62 | 1.69x | $11.48 | $1.8M | 110.4K | 16 |
| 2020 | $26.19 | $15.54 | 1.69x | $10.65 | $2.1M | 132.5K | 16 |
| 2021 | $26.55 | $15.05 | 1.76x | $11.50 | $2.2M | 145.7K | 19 |
| 2022 | $24.68 | $11.58 | 2.13x | $13.10 | $2.9M | 246.5K | 21 |
| 2023 | $23.04 | $10.23 | 2.25x | $12.81 | $3.5M | 340.2K | 20 |
| 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) | 133.0K | $5.0M | $37.86 | 1.61x |
| J0897 | Injection, denosumab, 1 mg | 192.8K | $3.0M | $15.33 | 1.58x |
| 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) | 493.4K | $2.6M | $5.21 | 1.88x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 52.0K | $2.2M | $43.15 | 2.24x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 88.5K | $998.6K | $11.29 | 3.10x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 132.3K | $990.5K | $7.49 | 1.50x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 4.9K | $407.5K | $82.80 | 1.70x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 6.4K | $369.7K | $57.75 | 1.51x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 3.4K | $362.0K | $105.63 | 3.79x |
| J3262 | Injection, tocilizumab, 1 mg | 73.5K | $345.4K | $4.70 | 1.70x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 4.5K | $243.4K | $54.44 | 1.78x |
| J7325 | Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg | 14.4K | $140.1K | $9.69 | 2.03x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.1K | $136.8K | $120.94 | 1.61x |
| J7326 | Hyaluronan or derivative, gel-one, for intra-articular injection, per dose | 75 | $69.7K | $929.20 | 1.51x |
| 99442 | Telephone medical discussion with physician, 11-20 minutes | 784 | $48.0K | $61.23 | 1.65x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 818 | $41.0K | $50.11 | 2.49x |
| 20610 | Aspiration and/or injection of fluid from large joint | 843 | $40.1K | $47.52 | 3.29x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 1.3K | $30.3K | $22.79 | 3.29x |
| J3489 | Injection, zoledronic acid, 1 mg | 2.1K | $24.8K | $12.07 | 9.16x |
| 99441 | Telephone medical discussion with physician, 5-10 minutes | 666 | $23.6K | $35.37 | 1.90x |
This provider submits charges 1.89 times higher than what Medicare actually pays.
A markup ratio of 1.89x means for every $100 Medicare pays, this provider initially charges $189. This is lower 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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