⚠️ This provider averages 1.1K services per working day — physically unusual for an individual practitioner
Based on 2.9M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $39.0M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 1.1K 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 | $22.05 | $12.53 | 1.76x | $9.52 | $2.8M | 225.7K | 46 |
| 2015 | $22.54 | $13.40 | 1.68x | $9.14 | $3.9M | 289.6K | 47 |
| 2016 | $21.94 | $12.70 | 1.73x | $9.24 | $4.2M | 334.3K | 45 |
| 2017 | $22.93 | $14.22 | 1.61x | $8.71 | $4.4M | 312.6K | 47 |
| 2018 | $27.62 | $17.93 | 1.54x | $9.69 | $4.8M | 268.8K | 49 |
| 2019 | $27.97 | $17.21 | 1.63x | $10.76 | $4.2M | 244.1K | 46 |
| 2020 | $26.76 | $15.67 | 1.71x | $11.09 | $3.9M | 250.0K | 46 |
| 2021 | $22.36 | $12.45 | 1.80x | $9.91 | $3.5M | 283.7K | 45 |
| 2022 | $21.08 | $11.25 | 1.87x | $9.83 | $3.5M | 307.6K | 45 |
| 2023 | $19.91 | $10.60 | 1.88x | $9.31 | $3.7M | 348.6K | 45 |
| 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) | 252.4K | $8.3M | $32.86 | 1.42x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 387.9K | $6.0M | $15.52 | 1.96x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 94.4K | $4.8M | $51.06 | 1.72x |
| 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) | 677.6K | $3.7M | $5.43 | 1.77x |
| J3262 | Injection, tocilizumab, 1 mg | 883.3K | $3.1M | $3.51 | 1.39x |
| J0897 | Injection, denosumab, 1 mg | 213.7K | $3.1M | $14.29 | 1.48x |
| J9310 | Injection, rituximab, 100 mg | 2.7K | $1.7M | $650.53 | 1.43x |
| J9312 | Injection, rituximab, 10 mg | 21.4K | $1.5M | $71.00 | 1.53x |
| J3357 | Ustekinumab, for subcutaneous injection, 1 mg | 8.9K | $1.3M | $147.78 | 1.45x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 142.6K | $1.1M | $7.60 | 1.45x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 16.0K | $805.2K | $50.27 | 1.82x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 8.5K | $765.8K | $90.58 | 2.45x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 9.4K | $679.7K | $72.11 | 1.95x |
| 76881 | Complete ultrasound scan of joint | 5.4K | $207.2K | $38.25 | 2.88x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.6K | $173.4K | $109.42 | 1.80x |
| 20610 | Aspiration and/or injection of fluid from large joint | 4.5K | $172.0K | $38.47 | 2.71x |
| 77080 | Dxa bone density measurement of hip, pelvis, spine | 3.8K | $135.7K | $36.11 | 3.32x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 15.1K | $133.4K | $8.80 | 2.84x |
| 96372 | Injection of drug or substance under skin or into muscle | 10.4K | $133.2K | $12.75 | 2.35x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 2.9K | $130.0K | $44.81 | 1.79x |
This provider submits charges 1.71 times higher than what Medicare actually pays.
A markup ratio of 1.71x means for every $100 Medicare pays, this provider initially charges $171. 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 |
|---|---|---|---|
| Richard Jones, MD | Northport, AL | $50.8M | ✓ 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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