⚠️ This provider averages 594 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 $27.9M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 594 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 58% 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 | $53.93 | $18.47 | 2.92x | $35.46 | $2.0M | 107.2K | 64 |
| 2015 | $50.43 | $18.79 | 2.68x | $31.64 | $2.3M | 120.7K | 59 |
| 2016 | $52.80 | $21.50 | 2.46x | $31.30 | $2.4M | 113.1K | 56 |
| 2017 | $56.59 | $23.58 | 2.40x | $33.01 | $2.6M | 108.8K | 61 |
| 2018 | $60.17 | $26.01 | 2.31x | $34.16 | $2.7M | 104.5K | 63 |
| 2019 | $43.33 | $17.83 | 2.43x | $25.50 | $3.0M | 169.2K | 60 |
| 2020 | $45.96 | $19.33 | 2.38x | $26.63 | $3.1M | 162.5K | 54 |
| 2021 | $48.73 | $19.96 | 2.44x | $28.77 | $3.2M | 162.1K | 58 |
| 2022 | $44.67 | $16.55 | 2.70x | $28.12 | $3.4M | 204.5K | 60 |
| 2023 | $40.75 | $13.43 | 3.03x | $27.32 | $3.1M | 232.3K | 60 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 119.2K | $6.1M | $50.91 | 2.46x |
| 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) | 123.6K | $4.6M | $36.93 | 1.81x |
| J9312 | Injection, rituximab, 10 mg | 65.0K | $4.5M | $69.49 | 1.74x |
| J3262 | Injection, tocilizumab, 1 mg | 803.5K | $3.1M | $3.85 | 3.94x |
| J9310 | Injection, rituximab, 100 mg | 4.4K | $2.7M | $614.93 | 1.46x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 102.9K | $1.3M | $12.39 | 3.27x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 11.5K | $893.0K | $77.38 | 3.36x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 7.3K | $738.6K | $101.75 | 2.72x |
| J0897 | Injection, denosumab, 1 mg | 40.3K | $615.9K | $15.28 | 1.98x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 10.3K | $525.6K | $51.16 | 2.47x |
| 20610 | Aspiration and/or injection of fluid from large joint | 7.7K | $344.7K | $44.90 | 2.76x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 5.4K | $119.2K | $21.92 | 8.75x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 2.3K | $117.5K | $50.13 | 5.29x |
| 86235 | Measurement of antibody for assessment of autoimmune disorder, any method | 5.5K | $116.7K | $21.05 | 3.51x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 12.8K | $116.5K | $9.12 | 8.32x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.0K | $113.3K | $113.33 | 2.66x |
| 82306 | Vitamin d-3 level | 2.2K | $74.4K | $34.01 | 3.24x |
| J7332 | Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg | 4.7K | $73.9K | $15.65 | 2.65x |
| 86481 | Tuberculosis test, enumeration of t-cells | 749 | $73.9K | $98.63 | 1.83x |
| J7321 | Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose | 1.1K | $71.9K | $66.16 | 5.52x |
This provider submits charges 2.57 times higher than what Medicare actually pays.
A markup ratio of 2.57x means for every $100 Medicare pays, this provider initially charges $257. 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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