⚠️ This provider averages 749 services per working day — physically unusual for an individual practitioner
Based on 1.9M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $19.0M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 749 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 5948% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 353% in 2016
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 | $173.54 | $91.13 | 1.90x | $82.41 | $50.7K | 556 | 9 |
| 2015 | $15.69 | $7.65 | 2.05x | $8.04 | $218.5K | 28.6K | 11 |
| 2016 | $20.28 | $11.87 | 1.71x | $8.41 | $989.5K | 83.4K | 20 |
| 2017 | $16.28 | $9.90 | 1.64x | $6.38 | $1.7M | 170.3K | 23 |
| 2018 | $19.96 | $11.60 | 1.72x | $8.36 | $2.2M | 187.5K | 20 |
| 2019 | $20.81 | $10.57 | 1.97x | $10.24 | $2.6M | 249.2K | 19 |
| 2020 | $23.16 | $11.35 | 2.04x | $11.81 | $2.7M | 234.8K | 22 |
| 2021 | $24.59 | $10.18 | 2.42x | $14.41 | $2.8M | 279.7K | 22 |
| 2022 | $26.57 | $9.32 | 2.85x | $17.25 | $2.7M | 290.1K | 22 |
| 2023 | $30.76 | $8.80 | 3.50x | $21.96 | $3.1M | 348.1K | 22 |
| 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) | 190.8K | $7.3M | $38.16 | 1.99x |
| 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) | 923.2K | $5.1M | $5.57 | 2.41x |
| J3262 | Injection, tocilizumab, 1 mg | 560.9K | $2.4M | $4.32 | 2.26x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 122.6K | $1.7M | $13.67 | 3.41x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 7.1K | $556.8K | $78.84 | 2.66x |
| J0897 | Injection, denosumab, 1 mg | 26.3K | $408.6K | $15.51 | 2.00x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 3.6K | $363.0K | $101.07 | 2.74x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 9.8K | $289.3K | $29.61 | 3.71x |
| J9310 | Injection, rituximab, 100 mg | 240 | $161.8K | $674.12 | 1.51x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 2.5K | $144.4K | $57.07 | 2.52x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 947 | $102.7K | $108.43 | 2.78x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 1.7K | $86.6K | $50.33 | 2.63x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1.7K | $82.2K | $48.95 | 2.80x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 529 | $73.3K | $138.50 | 2.38x |
| 99215 | Established patient outpatient visit, total time 40-54 minutes | 750 | $70.9K | $94.49 | 2.36x |
| 80053 | Blood test, comprehensive group of blood chemicals | 2.9K | $32.2K | $11.05 | 2.75x |
| 96372 | Injection of drug or substance under skin or into muscle | 2.3K | $26.7K | $11.84 | 2.72x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 2.8K | $23.3K | $8.26 | 2.94x |
| 86140 | Measurement c-reactive protein for detection of infection or inflammation | 2.8K | $15.6K | $5.56 | 3.02x |
| 86480 | Tuberculosis test, gamma interferon | 200 | $12.1K | $60.52 | 2.48x |
This provider submits charges 2.35 times higher than what Medicare actually pays.
A markup ratio of 2.35x means for every $100 Medicare pays, this provider initially charges $235. 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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