⚠️ This provider averages 1.1K services per working day — physically unusual for an individual practitioner
Based on 2.7M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $52.6M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 1.1K services per working day raises questions about billing patterns.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 90% 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 | $49.65 | $19.20 | 2.59x | $30.45 | $4.6M | 237.1K | 65 |
| 2015 | $81.25 | $22.97 | 3.54x | $58.28 | $5.2M | 228.5K | 65 |
| 2016 | $115.52 | $26.27 | 4.40x | $89.25 | $5.9M | 225.7K | 66 |
| 2017 | $98.04 | $24.12 | 4.06x | $73.92 | $2.3M | 95.8K | 43 |
| 2018 | $122.28 | $32.08 | 3.81x | $90.20 | $4.4M | 136.9K | 25 |
| 2019 | $114.53 | $30.26 | 3.78x | $84.27 | $5.8M | 191.1K | 26 |
| 2020 | $69.22 | $18.52 | 3.74x | $50.70 | $7.9M | 426.5K | 27 |
| 2021 | $58.44 | $14.38 | 4.06x | $44.06 | $6.3M | 436.8K | 24 |
| 2022 | $50.26 | $12.83 | 3.92x | $37.43 | $5.3M | 414.9K | 24 |
| 2023 | $54.28 | $13.68 | 3.97x | $40.60 | $4.9M | 356.0K | 25 |
| 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) | 400.1K | $14.8M | $37.07 | 3.76x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 195.8K | $10.9M | $55.61 | 3.76x |
| J9310 | Injection, rituximab, 100 mg | 8.0K | $4.8M | $602.90 | 3.61x |
| 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) | 837.6K | $4.5M | $5.35 | 4.10x |
| J2507 | Injection, pegloticase, 1 mg | 2.3K | $4.3M | $1.9K | 3.69x |
| J9312 | Injection, rituximab, 10 mg | 59.8K | $4.2M | $70.42 | 3.87x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 18.0K | $1.4M | $75.68 | 2.77x |
| J3262 | Injection, tocilizumab, 1 mg | 421.7K | $1.3M | $3.01 | 3.64x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 12.4K | $1.2M | $93.33 | 4.89x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 73.5K | $859.9K | $11.70 | 4.04x |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | 18.4K | $843.5K | $45.74 | 5.07x |
| J7328 | Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg | 520.8K | $794.4K | $1.53 | 2.01x |
| J0897 | Injection, denosumab, 1 mg | 30.5K | $449.3K | $14.71 | 3.77x |
| 20611 | Aspiration and/or injection of fluid large joint using ultrasound guidance | 3.9K | $319.4K | $82.34 | 3.03x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 5.4K | $289.9K | $53.89 | 4.74x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 9.2K | $185.6K | $20.18 | 4.43x |
| J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose | 1.1K | $137.5K | $119.96 | 4.04x |
| J3304 | Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg | 9.0K | $125.0K | $13.95 | 2.35x |
| 96375 | Injection of additional new drug or substance into vein | 8.5K | $117.5K | $13.90 | 4.35x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1.9K | $87.7K | $45.64 | 2.85x |
This provider submits charges 3.8 times higher than what Medicare actually pays.
A markup ratio of 3.8x means for every $100 Medicare pays, this provider initially charges $380. 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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