⚠️ This provider averages 1.3K services per working day — physically unusual for an individual practitioner
Based on 3.3M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $38.5M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 1.3K services per working day raises questions about billing patterns.
Medicare payments to this provider grew 104% 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 | $37.07 | $13.69 | 2.71x | $23.38 | $2.4M | 172.6K | 72 |
| 2015 | $36.50 | $14.45 | 2.53x | $22.05 | $2.6M | 178.7K | 70 |
| 2016 | $32.16 | $13.48 | 2.39x | $18.68 | $3.1M | 233.1K | 68 |
| 2017 | $31.29 | $13.93 | 2.25x | $17.36 | $3.3M | 234.7K | 69 |
| 2018 | $32.61 | $15.24 | 2.14x | $17.37 | $3.9M | 253.8K | 69 |
| 2019 | $30.41 | $13.98 | 2.18x | $16.43 | $3.8M | 269.3K | 69 |
| 2020 | $27.01 | $12.44 | 2.17x | $14.57 | $4.1M | 326.6K | 64 |
| 2021 | $25.51 | $10.76 | 2.37x | $14.75 | $5.2M | 479.2K | 64 |
| 2022 | $25.79 | $9.54 | 2.70x | $16.25 | $5.5M | 572.2K | 66 |
| 2023 | $25.66 | $8.79 | 2.92x | $16.87 | $4.8M | 548.1K | 64 |
| 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) | 223.8K | $8.1M | $36.02 | 1.90x |
| 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) | 1.5M | $7.8M | $5.27 | 2.09x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 144.2K | $7.1M | $49.44 | 2.79x |
| J3262 | Injection, tocilizumab, 1 mg | 716.7K | $2.9M | $4.01 | 2.24x |
| J0897 | Injection, denosumab, 1 mg | 133.1K | $2.0M | $15.34 | 2.45x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 146.6K | $1.9M | $13.27 | 3.16x |
| J9312 | Injection, rituximab, 10 mg | 27.7K | $1.9M | $70.04 | 2.00x |
| J9310 | Injection, rituximab, 100 mg | 2.7K | $1.7M | $611.16 | 1.71x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 11.2K | $829.0K | $74.04 | 2.96x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 79.6K | $605.6K | $7.61 | 2.37x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 4.8K | $443.1K | $91.65 | 3.72x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 4.3K | $207.4K | $48.33 | 3.29x |
| 86141 | Measurement c-reactive protein for detection of infection or inflammation, high sensitivity | 12.8K | $194.1K | $15.11 | 3.04x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 4.1K | $193.7K | $47.18 | 2.90x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 1.6K | $180.6K | $115.08 | 3.18x |
| J7325 | Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg | 18.3K | $172.8K | $9.45 | 3.07x |
| 85027 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 17.4K | $131.7K | $7.59 | 5.14x |
| 20610 | Aspiration and/or injection of fluid from large joint | 3.3K | $123.0K | $37.05 | 5.05x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 2.4K | $121.3K | $49.88 | 3.37x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 761 | $108.8K | $143.03 | 3.03x |
This provider submits charges 2.44 times higher than what Medicare actually pays.
A markup ratio of 2.44x means for every $100 Medicare pays, this provider initially charges $244. 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.
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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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