This provider's $3.9M in total Medicare payments ranks in the 95th percentile of Rheumatology providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
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 | $171.20 | $53.06 | 3.23x | $118.14 | $287.4K | 6.9K | 4.0K |
| 2015 | $195.10 | $58.43 | 3.34x | $136.67 | $353.1K | 7.6K | 4.4K |
| 2016 | $157.24 | $51.29 | 3.07x | $105.95 | $356.8K | 5.8K | 2.5K |
| 2017 | $348.63 | $91.12 | 3.83x | $257.51 | $362.9K | 5.4K | 1.7K |
| 2018 | $317.96 | $83.97 | 3.79x | $233.99 | $423.3K | 6.5K | 2.2K |
| 2019 | $241.85 | $66.84 | 3.62x | $175.01 | $585.5K | 10.8K | 4.2K |
| 2020 | $293.50 | $84.81 | 3.46x | $208.69 | $375.7K | 6.6K | 1.9K |
| 2021 | $213.74 | $78.52 | 2.72x | $135.22 | $395.1K | 6.0K | 1.6K |
| 2022 | $263.27 | $90.49 | 2.91x | $172.78 | $355.6K | 5.6K | 1.4K |
| 2023 | $242.06 | $81.97 | 2.95x | $160.09 | $380.1K | 6.7K | 1.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 17.0K | $1.2M | $72.24 | 2.25x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 7.1K | $504.3K | $71.07 | 2.16x |
| 20611 | Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance | 2.8K | $243.6K | $86.22 | 2.33x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.5K | $239.0K | $95.60 | 2.28x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.0K | $143.7K | $141.18 | 3.09x |
| J7321 | Hyaluronan or derivative, hyalgan or supartz, for intra-articular injection, per dose | 2.0K | $128.0K | $64.66 | 3.09x |
| 93925 | Ultrasound study of arteries and arterial grafts of both legs | 530 | $119.3K | $225.08 | 2.59x |
| 93970 | Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers | 535 | $93.2K | $174.17 | 3.42x |
| 73721 | MRI scan of leg joint | 428 | $93.2K | $217.67 | 6.04x |
| 93880 | Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck | 491 | $87.2K | $177.66 | 3.29x |
| 96413 | Infusion of chemotherapy into a vein up to 1 hour | 556 | $73.3K | $131.89 | 3.40x |
| 97110 | Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 3.0K | $70.6K | $23.39 | 3.55x |
| 93930 | Ultrasound study of arteries and arterial grafts of both arms | 338 | $64.0K | $189.41 | 2.99x |
| 93306 | Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function | 324 | $63.7K | $196.60 | 3.77x |
| 73218 | MRI scan of arm | 212 | $61.9K | $291.88 | 4.48x |
| 73221 | MRI scan of arm joint | 242 | $52.3K | $216.29 | 6.07x |
| 97530 | Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes | 1.8K | $52.1K | $29.65 | 3.04x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour | 609 | $39.5K | $64.86 | 2.47x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 889 | $33.5K | $37.63 | 1.36x |
| 97140 | Manual (physical) therapy techniques to 1 or more regions, each 15 minutes | 1.7K | $32.4K | $19.44 | 3.96x |
This provider submits charges 2.74 times higher than what Medicare actually pays.
A markup ratio of 2.74x means for every $100 Medicare pays, this provider initially charges $274. This is higher 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 Rheumatology providers in NY for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Barry Gruber, M.D. | Babylon, NY | $33.9M | ✓ 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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