⚠️ This provider averages 466 services per working day — physically unusual for an individual practitioner
Based on 1.2M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $14.2M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 466 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 4419% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 1001% 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 | $176.30 | $68.48 | 2.57x | $107.82 | $79.6K | 1.2K | 7 |
| 2015 | $162.06 | $61.32 | 2.64x | $100.74 | $61.1K | 997 | 7 |
| 2016 | $144.40 | $57.57 | 2.51x | $86.83 | $18.7K | 324 | 4 |
| 2017 | $85.31 | $24.41 | 3.49x | $60.90 | $112.5K | 4.6K | 17 |
| 2018 | $91.06 | $23.81 | 3.82x | $67.25 | $1.2M | 52.0K | 13 |
| 2019 | $73.68 | $18.58 | 3.97x | $55.10 | $2.2M | 118.8K | 16 |
| 2020 | $51.69 | $13.47 | 3.84x | $38.22 | $2.7M | 198.6K | 17 |
| 2021 | $47.87 | $12.30 | 3.89x | $35.57 | $1.8M | 150.3K | 18 |
| 2022 | $41.65 | $9.40 | 4.43x | $32.25 | $2.4M | 253.0K | 16 |
| 2023 | $44.42 | $9.37 | 4.74x | $35.05 | $3.6M | 384.0K | 19 |
| 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) | 136.8K | $5.3M | $38.40 | 4.31x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 278.8K | $3.9M | $14.15 | 4.37x |
| J3262 | Injection, tocilizumab, 1 mg | 376.0K | $1.7M | $4.46 | 3.56x |
| 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) | 249.2K | $1.2M | $4.74 | 5.27x |
| J0897 | Injection, denosumab, 1 mg | 35.4K | $594.5K | $16.80 | 3.32x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 66.8K | $498.5K | $7.46 | 3.02x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 2.4K | $233.7K | $99.40 | 4.47x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 2.6K | $208.1K | $78.69 | 2.83x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1.6K | $90.2K | $55.70 | 2.85x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 1.8K | $84.4K | $47.67 | 4.20x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.6K | $83.2K | $53.36 | 2.60x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 2.5K | $63.6K | $24.96 | 5.41x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 504 | $56.7K | $112.50 | 2.49x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 883 | $51.3K | $58.11 | 4.34x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 288 | $42.1K | $146.18 | 2.68x |
| 73130 | X-ray of hand, minimum of 3 views | 1.1K | $25.7K | $22.93 | 3.31x |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 311 | $23.2K | $74.70 | 3.01x |
| 96372 | Injection of drug or substance under skin or into muscle | 2.0K | $21.7K | $10.82 | 3.95x |
| 99238 | Hospital discharge day management, 30 minutes or less | 327 | $17.5K | $53.49 | 2.54x |
| 73630 | X-ray of foot, minimum of 3 views | 505 | $11.0K | $21.86 | 3.56x |
This provider submits charges 4.17 times higher than what Medicare actually pays.
A markup ratio of 4.17x means for every $100 Medicare pays, this provider initially charges $417. 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 OK for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Craig Carson, M.D. | Edmond, OK | $72.8M | ✓ 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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