This provider's $3.9M in total Medicare payments ranks in the 98th percentile of Nephrology providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
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 | $203.24 | $114.12 | 1.78x | $89.12 | $317.9K | 2.7K | 1.0K |
| 2015 | $404.98 | $117.46 | 3.45x | $287.52 | $351.5K | 3.0K | 1.0K |
| 2016 | $402.25 | $113.83 | 3.53x | $288.42 | $299.0K | 2.7K | 998 |
| 2017 | $302.13 | $116.80 | 2.59x | $185.33 | $337.8K | 2.9K | 1.1K |
| 2018 | $281.41 | $107.73 | 2.61x | $173.68 | $435.6K | 3.8K | 1.4K |
| 2019 | $223.70 | $107.99 | 2.07x | $115.71 | $436.0K | 3.8K | 1.4K |
| 2020 | $234.44 | $115.99 | 2.02x | $118.45 | $393.3K | 3.1K | 1.1K |
| 2021 | $272.93 | $118.90 | 2.30x | $154.03 | $478.4K | 4.0K | 1.5K |
| 2022 | $291.36 | $126.59 | 2.30x | $164.77 | $454.7K | 3.6K | 1.3K |
| 2023 | $308.63 | $139.96 | 2.21x | $168.67 | $387.2K | 3.1K | 1.1K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 90966 | Home dialysis services per month, patient 20 years of age or older | 4.3K | $865.8K | $199.08 | 1.93x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 8.9K | $728.5K | $81.65 | 2.01x |
| 90960 | Dialysis services (4 or more physician visits per month), patient 20 years of age and older | 2.7K | $635.7K | $238.70 | 2.08x |
| 99291 | Critical care delivery critically ill or injured patient, first 30-74 minutes | 3.0K | $515.9K | $174.16 | 2.30x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 2.7K | $423.3K | $154.54 | 2.11x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 6.6K | $375.0K | $57.14 | 2.17x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 976 | $86.7K | $88.78 | 2.48x |
| 90961 | Dialysis services (2-3 physician visits per month), patient 20 years of age and older | 395 | $77.0K | $194.95 | 1.91x |
| 90935 | Hemodialysis procedure with one physician evaluation | 946 | $53.8K | $56.92 | 2.49x |
| 90945 | Dialysis procedure including one evaluation | 628 | $42.1K | $67.01 | 2.02x |
| G0180 | Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implem | 501 | $21.0K | $41.94 | 1.76x |
| G0179 | Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp | 424 | $13.8K | $32.52 | 1.91x |
| 36011 | Insertion of catheter into vein | 99 | $12.2K | $123.70 | 14.02x |
| 90962 | Dialysis services, 1 physician visit per month (20 years or older) | 74 | $12.1K | $164.14 | 1.63x |
| 99204 | New patient outpatient visit, total time 45-59 minutes | 94 | $12.0K | $127.18 | 2.99x |
| 99239 | Hospital discharge day management, more than 30 minutes | 97 | $7.9K | $81.36 | 1.78x |
| 99292 | Critical care delivery critically ill or injured patient | 34 | $3.0K | $88.21 | 2.67x |
| 99491 | Chronic care management services by qualified health care professional, 30 minutes or more per calendar month | 28 | $1.9K | $66.54 | 1.76x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 71 | $1.3K | $18.33 | 1.64x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 11 | $931.81 | $84.71 | 2.18x |
This provider submits charges 2.12 times higher than what Medicare actually pays.
A markup ratio of 2.12x means for every $100 Medicare pays, this provider initially charges $212. 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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