This provider's $4.9M 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 | $354.02 | $105.98 | 3.34x | $248.04 | $458.2K | 2.8K | 864 |
| 2015 | $212.27 | $60.70 | 3.50x | $151.57 | $569.5K | 5.1K | 2.8K |
| 2016 | $184.56 | $47.28 | 3.90x | $137.28 | $678.3K | 6.7K | 3.3K |
| 2017 | $176.33 | $45.69 | 3.86x | $130.64 | $617.2K | 5.9K | 3.1K |
| 2018 | $232.26 | $66.25 | 3.51x | $166.01 | $534.9K | 4.0K | 1.8K |
| 2019 | $201.21 | $58.05 | 3.47x | $143.16 | $384.4K | 3.7K | 2.1K |
| 2020 | $232.88 | $68.94 | 3.38x | $163.94 | $368.3K | 2.8K | 1.2K |
| 2021 | $298.56 | $97.84 | 3.05x | $200.72 | $457.6K | 2.8K | 1.1K |
| 2022 | $316.01 | $96.15 | 3.29x | $219.86 | $457.6K | 2.9K | 1.2K |
| 2023 | $240.73 | $72.06 | 3.34x | $168.67 | $414.3K | 3.0K | 1.5K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 90960 | Dialysis services (4 or more physician visits per month), patient 20 years of age and older | 8.5K | $1.9M | $225.05 | 3.11x |
| 90961 | Dialysis services (2-3 physician visits per month), patient 20 years of age and older | 4.4K | $849.0K | $190.82 | 3.16x |
| 90966 | Home dialysis services per month, patient 20 years of age or older | 4.2K | $831.2K | $196.68 | 3.56x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 6.3K | $471.8K | $75.12 | 2.48x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 1.7K | $170.4K | $102.69 | 2.44x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 2.8K | $157.7K | $55.72 | 3.47x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.3K | $144.7K | $109.48 | 2.85x |
| 90962 | Dialysis services (1 physician visit per month), patient 20 years of age and older | 757 | $107.2K | $141.61 | 3.67x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 2.4K | $101.9K | $42.45 | 3.72x |
| 90935 | Hemodialysis procedure with one physician evaluation | 1.2K | $67.8K | $55.44 | 8.11x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 952 | $53.8K | $56.53 | 4.22x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 907 | $12.3K | $13.54 | 5.67x |
| 90945 | Dialysis procedure including one evaluation | 165 | $9.6K | $57.92 | 7.55x |
| 87426 | Elisa detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen | 169 | $7.2K | $42.39 | 2.89x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 37 | $5.6K | $152.12 | 1.97x |
| 87502 | Detection test for multiple types influenza virus | 49 | $4.7K | $96.66 | 1.63x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 47 | $4.4K | $93.39 | 3.35x |
| 71020 | X-ray of chest, 2 views, front and side | 304 | $4.0K | $13.08 | 6.17x |
| 90993 | Dialysis training, patient helper, course not completed | 213 | $3.4K | $15.91 | 2.19x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 22 | $3.0K | $137.99 | 3.91x |
This provider submits charges 3.24 times higher than what Medicare actually pays.
A markup ratio of 3.24x means for every $100 Medicare pays, this provider initially charges $324. 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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