This provider's $3.3M in total Medicare payments ranks in the 95th percentile of Rheumatology providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
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 | $87.24 | $35.43 | 2.46x | $51.81 | $328.7K | 13.0K | 5.4K |
| 2015 | $91.59 | $34.32 | 2.67x | $57.27 | $295.1K | 11.8K | 4.3K |
| 2016 | $94.35 | $36.24 | 2.60x | $58.11 | $315.4K | 12.4K | 4.7K |
| 2017 | $87.55 | $35.72 | 2.45x | $51.83 | $330.8K | 13.5K | 5.3K |
| 2018 | $97.64 | $34.39 | 2.84x | $63.25 | $316.9K | 12.8K | 5.0K |
| 2019 | $106.61 | $35.33 | 3.02x | $71.28 | $368.3K | 15.7K | 6.3K |
| 2020 | $103.31 | $32.14 | 3.21x | $71.17 | $316.6K | 14.0K | 5.2K |
| 2021 | $104.15 | $35.13 | 2.96x | $69.02 | $309.9K | 7.8K | 3.5K |
| 2022 | $151.38 | $54.30 | 2.79x | $97.08 | $336.4K | 6.2K | 2.3K |
| 2023 | $150.47 | $52.63 | 2.86x | $97.84 | $370.0K | 6.2K | 1.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 16.1K | $1.5M | $94.52 | 2.27x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.3K | $164.4K | $122.57 | 2.16x |
| 20611 | Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance | 1.6K | $131.6K | $80.41 | 3.45x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 1.7K | $109.1K | $65.04 | 2.75x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 801 | $105.4K | $131.58 | 2.51x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 5.3K | $88.1K | $16.53 | 3.95x |
| 96413 | Infusion of chemotherapy into a vein up to 1 hour | 714 | $87.0K | $121.85 | 2.74x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 450 | $75.7K | $168.21 | 2.42x |
| 82306 | Vitamin D-3 level | 1.9K | $67.2K | $36.02 | 2.33x |
| 86225 | Measurement of DNA antibody | 3.8K | $62.3K | $16.34 | 2.39x |
| 86160 | Measurement of complement (immune system proteins) | 4.1K | $59.5K | $14.40 | 2.95x |
| 80053 | Blood test, comprehensive group of blood chemicals | 6.0K | $58.8K | $9.79 | 3.72x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 6.0K | $56.5K | $9.45 | 2.87x |
| 76942 | Ultrasonic guidance imaging supervision and interpretation for insertion of needle | 860 | $49.4K | $57.47 | 4.09x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour | 757 | $48.5K | $64.08 | 4.08x |
| J0897 | Injection, denosumab, 1 mg | 3.1K | $46.1K | $14.69 | 2.06x |
| 83735 | Magnesium level | 4.9K | $39.5K | $8.05 | 2.07x |
| 86161 | Measurement of complement function (immune system proteins) | 2.4K | $37.7K | $15.73 | 3.18x |
| 86140 | Measurement C-reactive protein for detection of infection or inflammation | 5.4K | $33.9K | $6.30 | 8.68x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 529 | $33.6K | $63.59 | 2.05x |
This provider submits charges 2.7 times higher than what Medicare actually pays.
A markup ratio of 2.7x means for every $100 Medicare pays, this provider initially charges $270. 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 CA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Barry Eibschutz, M.D. | San Luis Obispo, CA | $55.8M | ✓ Clear |
| Shariar Cohen-Gadol, M.D. | Thousand Oaks, CA | $49.5M | ⚠️ Flagged |
| Gerald Ho, M.D. | La Palma, CA | $45.8M | ✓ Clear |
| Arash Horizon, M.D. | Los Angeles, CA | $45.0M | ✓ Clear |
| Daniel Watrous, M.D. | Visalia, CA | $41.6M | ✓ 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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