⚠️ This provider averages 591 services per working day — physically unusual for an individual practitioner
Based on 1.5M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $25.9M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 591 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 53% 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 | $31.38 | $17.31 | 1.81x | $14.07 | $1.9M | 111.7K | 31 |
| 2015 | $31.55 | $17.66 | 1.79x | $13.89 | $2.1M | 121.5K | 29 |
| 2016 | $25.83 | $14.03 | 1.84x | $11.80 | $2.3M | 166.0K | 38 |
| 2017 | $43.93 | $21.73 | 2.02x | $22.20 | $2.5M | 116.9K | 38 |
| 2018 | $56.67 | $26.54 | 2.14x | $30.13 | $2.5M | 92.8K | 40 |
| 2019 | $71.98 | $34.88 | 2.06x | $37.10 | $2.5M | 72.8K | 40 |
| 2020 | $40.23 | $19.02 | 2.12x | $21.21 | $3.1M | 165.2K | 35 |
| 2021 | $36.79 | $15.69 | 2.34x | $21.10 | $3.0M | 190.1K | 43 |
| 2022 | $38.91 | $14.72 | 2.64x | $24.19 | $2.9M | 198.4K | 45 |
| 2023 | $33.35 | $12.22 | 2.73x | $21.13 | $3.0M | 241.5K | 43 |
| 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) | 345.0K | $12.5M | $36.27 | 1.96x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 95.2K | $5.0M | $52.89 | 2.29x |
| 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) | 367.2K | $2.0M | $5.31 | 2.44x |
| J3262 | Injection, tocilizumab, 1 mg | 432.1K | $1.8M | $4.05 | 1.65x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 117.4K | $1.5M | $13.14 | 3.09x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 9.8K | $758.6K | $77.60 | 1.93x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 7.4K | $755.4K | $102.06 | 3.13x |
| J0897 | Injection, denosumab, 1 mg | 22.7K | $345.1K | $15.22 | 1.77x |
| 86235 | Measurement of antibody for assessment of autoimmune disorder, any method | 7.4K | $156.0K | $20.94 | 1.67x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 2.9K | $141.7K | $49.35 | 1.93x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 10.2K | $91.3K | $8.94 | 3.29x |
| 82306 | Vitamin d-3 level | 2.3K | $80.0K | $35.27 | 1.79x |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | 2.3K | $68.7K | $29.85 | 2.85x |
| 86481 | Tuberculosis test, enumeration of t-cells | 635 | $62.4K | $98.30 | 1.27x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 1.0K | $56.8K | $54.32 | 2.58x |
| 80076 | Liver function blood test panel | 7.0K | $56.4K | $8.04 | 7.47x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 959 | $52.1K | $54.31 | 2.21x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 397 | $45.4K | $114.44 | 1.58x |
| 86140 | Measurement c-reactive protein for detection of infection or inflammation | 7.2K | $40.5K | $5.66 | 7.95x |
| 82565 | Blood creatinine level | 7.4K | $34.8K | $4.70 | 4.47x |
This provider submits charges 2.18 times higher than what Medicare actually pays.
A markup ratio of 2.18x means for every $100 Medicare pays, this provider initially charges $218. 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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