This provider's $208.7M in total Medicare payments ranks in the 99th percentile of Pharmacy providers nationally.
Medicare payments to this provider grew 237% from 2017 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 153% in 2018
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 |
|---|---|---|---|---|---|---|---|
| 2017 | $204.58 | $117.17 | 1.75x | $87.41 | $11.2M | 95.7K | 4 |
| 2018 | $5.49 | $3.23 | 1.70x | $2.26 | $28.4M | 8.8M | 3 |
| 2019 | $2.35 | $1.34 | 1.75x | $1.01 | $37.3M | 27.8M | 7 |
| 2020 | $2.86 | $1.73 | 1.65x | $1.13 | $32.2M | 18.6M | 5 |
| 2021 | $3.54 | $2.13 | 1.66x | $1.41 | $32.5M | 15.3M | 7 |
| 2022 | $4.01 | $2.34 | 1.71x | $1.67 | $29.3M | 12.5M | 7 |
| 2023 | $4.59 | $2.67 | 1.72x | $1.92 | $37.8M | 14.1M | 7 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J7170 | Injection, emicizumab-kxwh, 0.5 mg | 1.4M | $54.2M | $37.97 | 1.66x |
| J7192 | Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified | 34.7M | $49.0M | $1.41 | 1.95x |
| J7205 | Injection, factor viii fc fusion protein (recombinant), per iu | 19.6M | $40.7M | $2.08 | 1.64x |
| J7195 | Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified | 17.4M | $26.3M | $1.51 | 1.41x |
| J7187 | Injection, von willebrand factor complex (humate-p), per iu vwf:rco | 17.5M | $20.4M | $1.17 | 1.72x |
| J7202 | Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u. | 4.0M | $13.9M | $3.50 | 1.57x |
| J7207 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u. | 2.4M | $3.1M | $1.32 | 1.91x |
| G0069 | Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes | 25.9K | $582.6K | $22.45 | 3.64x |
| J7211 | Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u. | 401.5K | $429.6K | $1.07 | 2.36x |
| G0068 | Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each inf | 3.5K | $95.3K | $27.10 | 4.97x |
| G0089 | Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes | 208 | $3.9K | $18.90 | 2.81x |
This provider submits charges 1.7 times higher than what Medicare actually pays.
A markup ratio of 1.7x means for every $100 Medicare pays, this provider initially charges $170. 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 Pharmacy providers in PA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Pentec Health Inc | Upper Chichester, PA | $44.2M | ⚠️ Flagged |
| Procare Pharmacy Direct, Llc. | Monroeville, PA | $37.2M | ✓ 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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