⚠️ This provider averages 659 services per working day — physically unusual for an individual practitioner
Based on 1.6M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $23.4M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 659 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 650% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 118% in 2016
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 | $82.57 | $35.10 | 2.35x | $47.47 | $447.5K | 12.7K | 29 |
| 2015 | $125.48 | $37.17 | 3.38x | $88.31 | $486.9K | 13.1K | 30 |
| 2016 | $104.58 | $27.92 | 3.75x | $76.66 | $1.1M | 38.0K | 31 |
| 2017 | $99.66 | $27.65 | 3.60x | $72.01 | $1.2M | 42.7K | 36 |
| 2018 | $83.18 | $29.33 | 2.84x | $53.85 | $1.7M | 57.0K | 35 |
| 2019 | $33.27 | $13.00 | 2.56x | $20.27 | $2.7M | 209.3K | 36 |
| 2020 | $28.19 | $11.29 | 2.50x | $16.90 | $3.5M | 307.6K | 38 |
| 2021 | $31.41 | $12.12 | 2.59x | $19.29 | $3.7M | 304.6K | 39 |
| 2022 | $45.41 | $16.78 | 2.71x | $28.63 | $5.3M | 314.9K | 37 |
| 2023 | $28.47 | $9.64 | 2.95x | $18.83 | $3.4M | 348.4K | 28 |
| 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) | 147.2K | $5.6M | $38.09 | 2.58x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 245.7K | $3.7M | $14.99 | 3.43x |
| 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) | 544.2K | $3.0M | $5.51 | 2.73x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 51.1K | $2.4M | $46.84 | 3.41x |
| J2507 | Injection, pegloticase, 1 mg | 720 | $1.7M | $2.4K | 2.29x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 206.6K | $1.6M | $7.51 | 2.39x |
| J3262 | Injection, tocilizumab, 1 mg | 314.8K | $1.4M | $4.42 | 2.31x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 10.0K | $780.1K | $78.32 | 2.14x |
| J0897 | Injection, denosumab, 1 mg | 35.4K | $592.2K | $16.74 | 2.41x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 4.7K | $484.3K | $103.04 | 3.84x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 4.2K | $243.7K | $58.00 | 2.43x |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | 6.1K | $215.6K | $35.11 | 3.70x |
| 76881 | Complete ultrasound scan of joint | 3.6K | $205.7K | $57.53 | 3.59x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.8K | $200.3K | $113.96 | 2.40x |
| 86235 | Measurement of antibody for assessment of autoimmune disorder, any method | 7.7K | $158.0K | $20.46 | 1.91x |
| 97112 | Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | 6.3K | $133.5K | $21.03 | 2.36x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 917 | $106.1K | $115.69 | 2.12x |
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 5.0K | $90.7K | $18.09 | 2.73x |
| 20610 | Aspiration and/or injection of fluid from large joint | 1.9K | $84.4K | $44.57 | 3.21x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 1.3K | $68.4K | $53.47 | 2.31x |
This provider submits charges 2.78 times higher than what Medicare actually pays.
A markup ratio of 2.78x means for every $100 Medicare pays, this provider initially charges $278. 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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