⚠️ This provider averages 223 services per working day — physically unusual for an individual practitioner
Based on 557.2K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $18.4M in total Medicare payments ranks in the 99th percentile of Pediatric Medicine providers nationally.
Averaging 223 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 327% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 66% in 2022
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 | $66.75 | $23.61 | 2.83x | $43.14 | $821.1K | 34.8K | 19 |
| 2015 | $74.02 | $28.13 | 2.63x | $45.89 | $1.1M | 38.4K | 19 |
| 2016 | $78.50 | $28.15 | 2.79x | $50.35 | $1.1M | 38.5K | 20 |
| 2017 | $79.84 | $26.87 | 2.97x | $52.97 | $1.5M | 54.3K | 21 |
| 2018 | $84.41 | $29.29 | 2.88x | $55.12 | $1.7M | 56.6K | 22 |
| 2019 | $84.78 | $29.91 | 2.83x | $54.87 | $1.8M | 60.0K | 28 |
| 2020 | $85.26 | $30.44 | 2.80x | $54.82 | $1.8M | 58.7K | 20 |
| 2021 | $85.73 | $33.84 | 2.53x | $51.89 | $2.0M | 58.1K | 18 |
| 2022 | $89.45 | $41.55 | 2.15x | $47.90 | $3.3M | 78.5K | 24 |
| 2023 | $92.86 | $44.24 | 2.10x | $48.62 | $3.5M | 79.2K | 19 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J1569 | Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg | 234.8K | $7.6M | $32.47 | 2.79x |
| J1556 | Injection, immune globulin (bivigam), 500 mg | 98.0K | $5.2M | $53.01 | 2.10x |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg | 77.1K | $2.0M | $25.41 | 3.08x |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 39.5K | $1.1M | $28.22 | 3.03x |
| J2182 | Injection, mepolizumab, 1 mg | 22.8K | $520.6K | $22.83 | 1.63x |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | 15.7K | $486.6K | $30.90 | 2.44x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 6.5K | $316.2K | $48.86 | 2.05x |
| J2357 | Injection, omalizumab, 5 mg | 9.3K | $261.4K | $27.97 | 1.95x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 2.8K | $228.4K | $81.92 | 1.82x |
| 96366 | Infusion into a vein for therapy, prevention, or diagnosis, each additional hour | 12.2K | $177.0K | $14.53 | 2.42x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 2.0K | $108.6K | $53.16 | 1.90x |
| 96374 | Injection of drug or substance into a vein for therapy, diagnosis, or prevention | 1.8K | $64.3K | $35.79 | 2.33x |
| 95165 | Professional service for preparation and provision of 1 or more antigens | 5.1K | $47.4K | $9.29 | 2.16x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 383 | $45.2K | $117.92 | 1.82x |
| 95004 | Test for allergy using allergenic extract | 10.7K | $41.0K | $3.82 | 2.23x |
| 96375 | Injection of additional new drug or substance into vein | 2.7K | $32.1K | $11.95 | 2.95x |
| 96372 | Injection of drug or substance under skin or into muscle | 2.1K | $25.9K | $12.30 | 2.10x |
| 95117 | Professional service for multiple injections of allergen | 2.7K | $18.8K | $7.08 | 4.02x |
| 94010 | Test to measure expiratory airflow and volume | 678 | $16.2K | $23.85 | 1.89x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 308 | $15.9K | $51.70 | 1.85x |
This provider submits charges 2.54 times higher than what Medicare actually pays.
A markup ratio of 2.54x means for every $100 Medicare pays, this provider initially charges $254. 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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