⚠️ This provider averages 433 services per working day — physically unusual for an individual practitioner
Based on 1.1M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $15.7M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 433 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 2210% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 145% 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 |
|---|---|---|---|---|---|---|---|
| 2014 | $153.80 | $54.62 | 2.82x | $99.18 | $143.1K | 2.6K | 19 |
| 2015 | $103.11 | $36.45 | 2.83x | $66.66 | $166.0K | 4.6K | 19 |
| 2016 | $95.35 | $44.51 | 2.14x | $50.84 | $377.6K | 8.5K | 21 |
| 2017 | $103.27 | $48.01 | 2.15x | $55.26 | $524.3K | 10.9K | 21 |
| 2018 | $52.28 | $20.60 | 2.54x | $31.68 | $1.3M | 62.3K | 20 |
| 2019 | $46.97 | $19.01 | 2.47x | $27.96 | $1.9M | 100.5K | 21 |
| 2020 | $46.69 | $17.85 | 2.62x | $28.84 | $2.4M | 136.1K | 22 |
| 2021 | $40.09 | $13.71 | 2.92x | $26.38 | $2.7M | 198.7K | 21 |
| 2022 | $40.85 | $11.89 | 3.44x | $28.96 | $2.8M | 234.7K | 21 |
| 2023 | $35.29 | $10.19 | 3.46x | $25.10 | $3.3M | 324.5K | 20 |
| 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) | 106.0K | $4.1M | $38.89 | 2.03x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 286.5K | $3.6M | $12.67 | 3.93x |
| 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) | 468.1K | $2.4M | $5.09 | 2.30x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 55.2K | $2.2M | $40.65 | 3.71x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 10.7K | $816.2K | $76.61 | 3.04x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 89.9K | $690.7K | $7.69 | 1.51x |
| J0897 | Injection, denosumab, 1 mg | 32.8K | $510.2K | $15.55 | 1.97x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 3.0K | $283.0K | $95.44 | 3.54x |
| J9312 | Injection, rituximab, 10 mg | 3.2K | $238.4K | $74.27 | 2.96x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 2.8K | $141.0K | $49.87 | 5.06x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 997 | $112.3K | $112.69 | 3.11x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 1.4K | $73.7K | $53.83 | 3.51x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 3.3K | $68.0K | $20.78 | 4.95x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1.3K | $65.7K | $51.16 | 3.04x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 482 | $46.6K | $96.65 | 2.79x |
| J3489 | Injection, zoledronic acid, 1 mg | 3.1K | $41.7K | $13.50 | 20.10x |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 473 | $33.8K | $71.53 | 3.28x |
| 96372 | Injection of drug or substance under skin or into muscle | 2.8K | $33.6K | $12.15 | 4.91x |
| J3304 | Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg | 2.2K | $31.9K | $14.41 | 1.73x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 214 | $29.6K | $138.30 | 2.90x |
This provider submits charges 2.95 times higher than what Medicare actually pays.
A markup ratio of 2.95x means for every $100 Medicare pays, this provider initially charges $295. 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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