What a case costs. What a physician returns.
Window TTM Jul 2025–Jun 2026 · run-rate basis Apr–Jun 2026 · generated 7/11/2026, 5:50:00 AM · confidence MEDIUM-HIGH — volume/collections HIGH (bank-verified 0.2%); supplies invoice-grade on embolization, EST on stent/atherectomy; Bobby ROI robust across scenarios
ADP payroll · live bank-rail feed
566 ACH records · 2022-11-14 → 2026-08-21 · nightly refresh, no portal login · updated 8/24/2026, 2:15:10 AM
Brian 'Bobby' Chiong, MD
$650K base + $250/wRVU above 8 wRVU per working day (Exhibit A, administered literally — realized bonus ≈ $430–510K/yr) · attribution: case-log emails × WCH claims (316 cases, 95.6% matched; all claims render under George). OON matched by initials+DOS (settlement-lag limited).
Practice revenue · in-network + out-of-network
OON entities: Avenue U Kings County Medical PLLC 70% · American Vascular Medical PLLC (Bronx) 30% · Oak Vein and Vascular PLLC 0%. Bobby OON matched (settlement-lag floor) $32,634 — Direct initials+DOS match = $33K FLOOR only — settlement lag means Bobby's Feb–Jun cases mostly haven't paid/reported yet (Contego per-claim DOS ends 2026-05-11). His mature OON share tracks his ~40–46% embolization-franchise share → est. $250–500K/yr once seasoned.
Overhead · monthly $801,800
Nova ventures excluded ($41,330/mo separated out)
| staff payroll nonphysician | $340,838 |
| billing service wch | $142,858 |
| billing service contego oon | $35,987 |
| marketing | $90,629 |
| equipment smoothed | $42,400 |
| software it | $27,559 |
| business insurance | $27,438 |
| rent | $16,073 |
| health insurance | $15,922 |
| anesthesia centurion | $15,200 |
| utilities | $4,776 |
| other | $42,195 |
Per procedure type
variable supplies vs average paid
| Type | Supplies | Vol/yr | Avg paid |
|---|---|---|---|
| PAD revascularization | $3,740 | 179 | $15,015 |
| UFE | $780 | 281 | $7,656 |
| PAE | $605 | 273 | $7,540 |
| Misc embolization (AVM/pelvic) | $535 | 37 | $6,469 |
| GAE | $500 | 476 | $5,872 |
| HAE | $535 | 301 | $5,299 |
| Iliac vein stent | $2,610 | 299 | $4,354 |
| Venogram + IVUS + plasty (standalone) | $750 | 88 | $1,789 |
| Sclerotherapy 36466 | $45 | 5,569 | $1,200 |
| RFA ablation | $450 | 624 | $1,001 |
| Sclerotherapy 36465 | $45 | 1,024 | $916 |
| Microphlebectomy | $150 | 13 | $516 |
ADP payroll · via bank rail
566 ACH records 2022-11-14 → 2026-08-21 · Plaid-synced, no portal login · refreshed nightly
| Pay date | Net wages |
|---|---|
| 2026-08-17 | $208,092 |
| 2026-08-10 | $15,000 |
| 2026-08-03 | $193,170 |
| 2026-07-21 | $12,254 |
| 2026-07-20 | $206,566 |
| 2026-07-06 | $172,893 |
| 2026-06-25 | $13,618 |
| 2026-06-22 | $178,817 |
Assumptions
- Run-rate basis Apr–Jun 2026 (practice scaled ~35% in spring 2026; trailing-12 machine CPP alt: $1,125). Overhead corrected physician-comp-free ($93.2K/mo Bobby removed) with equipment capex smoothed.
- George's comp/draws excluded entirely (owner economics). Nova ventures ($41.3K/mo) and personal spend ($142.2K/mo) excluded.
- Denominator = interventional procedure-encounter (950/mo run-rate incl sclero/RFA). Majors-only secondary view: CPP $3,990 vs $6,716 paid (1,934 cases/yr).
- All figures in-network (WCH) collections basis, bank-verified to 0.2% ($23.4M/yr). OON module ON TOP: ~$2.78M/yr collected via Contego (Nimble RCM) for American Vascular Medical PLLC — ~660 cases/yr at ~$4,132 cash/case, fees 15%+$120/claim ($510K/yr), net ≈ +$2.0M/yr. Practice-wide ≈ $26.1M/yr.
- Bobby production $6.0M/yr = maturity-adjusted annualization (range $5.5–6.75M); evidenced floor $1.43M over gappy Feb–Jun logs; $22,663 collected per logged working day; his OON share not yet attributed (upside).
- wRVU = contract Exhibit-A table (embolization 4, stent 4/2, RFA 1, Varithena 0.5), not CMS; ~295/mo. Sedation $14 per sedated major case ($3 blended).
- Bobby ROI holds >250% in every tested scenario (marginal-hire 372%; with pro-rata overhead 287%; if bonus unpaid 643%).
Open unknowns
- Iliac venous stent unit price — no invoice found; ±$200K/yr on COGS and the thinnest major margin ($1,730). #1 ask.
- Bobby's exact ADP per-period ledger (realized gross triangulated 3 ways to $1.0–1.17M/yr; register unseen — portal descoped).
- Missing case logs 2/16–3/27 and post-6/19 (~$1M of his production unevidenced; totals are floors).
- Bamshad's comp rail — if W2 via ADP, staff payroll is still physician-contaminated ($359K rendered Feb–Jun).
- 36466→36465 billing migration Apr–Jun (~$280/session on ~750 sessions/mo — voluntary or payer-forced?)
- OON deposit rail — AVM PLLC inflows are NOT in the hub's connected accounts (bank connection missing).
- Chase card ••2151 spend (possible Google Ads/Marchex), Brooklyn imputed rent ($15–20K/mo if desired), 'Rich Varithena Pharma' Zelle channel ($40.4K/yr — compliance check).
- Whether Bobby's volume is additive vs substitutive (practice stepped up ~35% coincident with his arrival — suggests largely additive).