⚠️ This provider averages 491 services per working day — physically unusual for an individual practitioner
Based on 1.1M total services over 9 years (250 working days/year). Learn about impossible service volumes →
This provider's $20.1M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Their average markup ratio of 6.53x is significantly above the specialty median of 2.7x.
Averaging 491 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 38761% from 2015 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 7749% 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 |
|---|---|---|---|---|---|---|---|
| 2015 | $389.47 | $116.36 | 3.35x | $273.11 | $8.5K | 73 | 2 |
| 2016 | $273.28 | $74.96 | 3.65x | $198.32 | $39.7K | 529 | 8 |
| 2017 | $183.72 | $49.66 | 3.70x | $134.06 | $47.0K | 946 | 10 |
| 2018 | $115.89 | $22.73 | 5.10x | $93.16 | $3.7M | 162.2K | 43 |
| 2019 | $117.22 | $20.47 | 5.73x | $96.75 | $5.7M | 278.4K | 48 |
| 2020 | $117.48 | $19.03 | 6.17x | $98.45 | $2.1M | 108.0K | 40 |
| 2021 | $111.01 | $15.00 | 7.40x | $96.01 | $2.8M | 183.9K | 37 |
| 2022 | $140.26 | $17.40 | 8.06x | $122.86 | $2.5M | 142.4K | 39 |
| 2023 | $114.74 | $14.42 | 7.96x | $100.32 | $3.3M | 228.9K | 42 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 159.3K | $6.8M | $42.82 | 8.90x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 231.7K | $3.1M | $13.58 | 7.84x |
| 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) | 80.8K | $3.0M | $37.45 | 4.85x |
| J0490 | Injection, belimumab, 10 mg | 51.5K | $1.7M | $33.54 | 4.61x |
| J3262 | Injection, tocilizumab, 1 mg | 382.4K | $1.5M | $3.88 | 4.29x |
| J9312 | Injection, rituximab, 10 mg | 12.3K | $741.8K | $60.07 | 5.03x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 6.0K | $583.9K | $96.56 | 3.68x |
| J0897 | Injection, denosumab, 1 mg | 24.3K | $390.7K | $16.08 | 4.30x |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | 9.8K | $344.8K | $35.01 | 4.09x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 3.2K | $247.6K | $78.42 | 2.80x |
| J1569 | Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg | 7.1K | $239.9K | $33.61 | 4.54x |
| J9310 | Injection, rituximab, 100 mg | 300 | $192.7K | $642.37 | 4.45x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 20.6K | $160.9K | $7.82 | 4.05x |
| J0491 | Injection, anifrolumab-fnia, 1 mg | 10.8K | $134.2K | $12.42 | 3.91x |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | 3.8K | $122.7K | $32.20 | 10.38x |
| 96375 | Injection of additional new drug or substance into vein | 7.8K | $89.5K | $11.44 | 4.46x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 3.7K | $78.6K | $21.04 | 3.75x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 587 | $64.0K | $109.02 | 3.23x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 1.3K | $60.8K | $47.56 | 3.11x |
| J1720 | Injection, hydrocortisone sodium succinate, up to 100 mg | 5.1K | $53.6K | $10.55 | 3.96x |
This provider submits charges 6.53 times higher than what Medicare actually pays.
A markup ratio of 6.53x means for every $100 Medicare pays, this provider initially charges $653. 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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