⚠️ This provider averages 618 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 $24.2M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 618 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 145% 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 | $31.75 | $10.40 | 3.05x | $21.35 | $1.6M | 150.7K | 47 |
| 2015 | $32.42 | $11.11 | 2.92x | $21.31 | $1.6M | 140.1K | 42 |
| 2016 | $37.42 | $13.11 | 2.85x | $24.31 | $1.6M | 123.4K | 43 |
| 2017 | $76.56 | $26.18 | 2.92x | $50.38 | $1.7M | 63.9K | 47 |
| 2018 | $45.69 | $16.14 | 2.83x | $29.55 | $2.1M | 131.1K | 46 |
| 2019 | $56.20 | $20.43 | 2.75x | $35.77 | $2.6M | 125.3K | 44 |
| 2020 | $65.62 | $26.58 | 2.47x | $39.04 | $2.8M | 106.5K | 46 |
| 2021 | $44.02 | $18.16 | 2.42x | $25.86 | $3.4M | 186.3K | 50 |
| 2022 | $39.03 | $14.99 | 2.60x | $24.04 | $3.1M | 206.7K | 41 |
| 2023 | $35.50 | $12.37 | 2.87x | $23.13 | $3.8M | 310.7K | 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) | 250.3K | $9.1M | $36.41 | 2.04x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 49.4K | $2.4M | $48.39 | 2.20x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 25.9K | $2.1M | $82.40 | 2.09x |
| J0897 | Injection, denosumab, 1 mg | 129.9K | $2.0M | $15.52 | 2.36x |
| 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) | 270.4K | $1.1M | $4.17 | 3.19x |
| J3262 | Injection, tocilizumab, 1 mg | 310.8K | $956.5K | $3.08 | 1.92x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 110.9K | $802.4K | $7.24 | 1.99x |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | 19.2K | $700.6K | $36.52 | 3.30x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 13.2K | $693.2K | $52.38 | 2.41x |
| J3245 | Injection, tildrakizumab, 1 mg | 4.6K | $462.9K | $100.62 | 2.18x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 4.7K | $284.7K | $60.12 | 3.20x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 2.3K | $261.0K | $111.34 | 2.11x |
| 73130 | X-ray of hand, minimum of 3 views | 9.2K | $253.3K | $27.61 | 5.03x |
| 72110 | X-ray of lower and sacral spine, minimum of 4 views | 5.0K | $201.9K | $40.14 | 5.55x |
| 20610 | Aspiration and/or injection of fluid from large joint | 3.6K | $168.9K | $47.03 | 4.56x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 17.9K | $157.4K | $8.79 | 5.01x |
| 73560 | X-ray of knee, 1-2 views | 5.8K | $156.4K | $27.00 | 4.00x |
| 73630 | X-ray of foot, minimum of 3 views | 5.9K | $154.5K | $26.04 | 5.34x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 1.0K | $152.9K | $149.05 | 2.31x |
| 73600 | X-ray of ankle, 2 views | 5.9K | $149.8K | $25.34 | 4.26x |
This provider submits charges 2.73 times higher than what Medicare actually pays.
A markup ratio of 2.73x means for every $100 Medicare pays, this provider initially charges $273. 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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