⚠️ This provider averages 702 services per working day — physically unusual for an individual practitioner
Based on 1.8M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $27.1M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 702 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 61% from 2014 to 2023.
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 | $28.91 | $14.67 | 1.97x | $14.24 | $1.9M | 127.5K | 30 |
| 2015 | $42.34 | $22.03 | 1.92x | $20.31 | $2.1M | 97.5K | 32 |
| 2016 | $54.14 | $24.43 | 2.22x | $29.71 | $2.3M | 95.1K | 29 |
| 2017 | $41.54 | $19.29 | 2.15x | $22.25 | $2.7M | 137.7K | 31 |
| 2018 | $35.69 | $16.63 | 2.15x | $19.06 | $2.9M | 174.3K | 33 |
| 2019 | $37.09 | $16.87 | 2.20x | $20.22 | $3.1M | 181.7K | 40 |
| 2020 | $38.79 | $15.36 | 2.53x | $23.43 | $3.2M | 205.2K | 38 |
| 2021 | $39.03 | $14.28 | 2.73x | $24.75 | $3.1M | 219.8K | 36 |
| 2022 | $35.32 | $11.79 | 3.00x | $23.53 | $2.8M | 238.8K | 33 |
| 2023 | $32.67 | $10.87 | 3.01x | $21.80 | $3.0M | 277.8K | 35 |
| 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) | 171.4K | $6.2M | $36.10 | 1.84x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 97.6K | $4.9M | $49.84 | 3.20x |
| 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) | 599.2K | $3.2M | $5.33 | 2.35x |
| J9312 | Injection, rituximab, 10 mg | 36.1K | $2.5M | $68.81 | 2.20x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 141.4K | $2.2M | $15.43 | 2.85x |
| J9310 | Injection, rituximab, 100 mg | 3.1K | $1.9M | $601.38 | 1.82x |
| J0897 | Injection, denosumab, 1 mg | 111.2K | $1.7M | $15.26 | 2.18x |
| J3262 | Injection, tocilizumab, 1 mg | 421.7K | $1.7M | $3.93 | 2.04x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 90.9K | $683.2K | $7.51 | 2.66x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 9.9K | $525.7K | $53.07 | 2.16x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 6.1K | $439.0K | $72.41 | 2.20x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 3.0K | $290.9K | $97.62 | 2.82x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 4.3K | $218.2K | $50.86 | 3.27x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 775 | $83.1K | $107.23 | 2.60x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 3.6K | $76.8K | $21.46 | 6.69x |
| 96372 | Injection of drug or substance under skin or into muscle | 5.3K | $68.0K | $12.86 | 4.66x |
| 20610 | Aspiration and/or injection of fluid from large joint | 1.2K | $54.3K | $45.53 | 3.82x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 6.5K | $48.7K | $7.48 | 3.34x |
| 86481 | Tuberculosis test, enumeration of t-cells | 441 | $43.4K | $98.34 | 2.13x |
| J3489 | Injection, zoledronic acid, 1 mg | 1.9K | $38.0K | $19.88 | 9.87x |
This provider submits charges 2.43 times higher than what Medicare actually pays.
A markup ratio of 2.43x means for every $100 Medicare pays, this provider initially charges $243. 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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