This provider's $4.6M in total Medicare payments ranks in the 98th percentile of Nephrology providers nationally.
Their average markup ratio of 5.56x is significantly above the specialty median of 2.9x.
Medicare payments to this provider grew 70% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 90% in 2018
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 | $651.09 | $130.38 | 4.99x | $520.71 | $275.5K | 2.6K | 1.0K |
| 2015 | $686.81 | $136.10 | 5.05x | $550.71 | $283.9K | 2.0K | 1.0K |
| 2016 | $766.28 | $138.11 | 5.55x | $628.17 | $329.2K | 2.2K | 1.0K |
| 2017 | $766.28 | $137.99 | 5.55x | $628.29 | $351.5K | 2.3K | 952 |
| 2018 | $761.82 | $150.75 | 5.05x | $611.07 | $667.6K | 3.4K | 1.2K |
| 2019 | $789.67 | $135.28 | 5.84x | $654.39 | $585.1K | 3.0K | 885 |
| 2020 | $810.27 | $140.50 | 5.77x | $669.77 | $582.3K | 2.9K | 919 |
| 2021 | $874.42 | $170.47 | 5.13x | $703.95 | $566.9K | 2.4K | 851 |
| 2022 | $926.64 | $175.53 | 5.28x | $751.11 | $493.6K | 2.1K | 666 |
| 2023 | $979.30 | $172.76 | 5.67x | $806.54 | $467.5K | 2.1K | 562 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 90960 | Dialysis services (4 or more physician visits per month), patient 20 years of age and older | 6.5K | $2.1M | $319.96 | 5.57x |
| 90961 | Dialysis services (2-3 physician visits per month), patient 20 years of age and older | 3.3K | $876.7K | $267.29 | 5.34x |
| 90966 | Home dialysis services per month, patient 20 years of age or older | 1.7K | $444.9K | $265.61 | 5.61x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 3.0K | $229.8K | $77.14 | 4.99x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.3K | $220.8K | $94.00 | 3.91x |
| 90935 | Hemodialysis procedure with one physician evaluation | 2.5K | $198.1K | $79.40 | 9.43x |
| 90962 | Dialysis services (1 physician visit per month), patient 20 years of age and older | 548 | $107.8K | $196.79 | 5.25x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 466 | $97.8K | $209.91 | 4.45x |
| 90945 | Dialysis procedure including one evaluation | 1.0K | $95.3K | $93.00 | 8.54x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 287 | $40.9K | $142.59 | 5.65x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 601 | $39.1K | $65.11 | 4.01x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 190 | $38.6K | $202.91 | 2.78x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 215 | $33.1K | $154.11 | 3.18x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 298 | $31.8K | $106.72 | 4.40x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 663 | $28.4K | $42.79 | 6.91x |
| 99239 | Hospital discharge day management, more than 30 minutes | 176 | $20.4K | $115.73 | 6.04x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 71 | $9.8K | $138.03 | 3.32x |
| 90970 | Dialysis services, per day (less than full month service), patient 20 years of age or older | 1.1K | $8.9K | $8.20 | 5.07x |
| 99238 | Hospital discharge day management, 30 minutes or less | 51 | $3.9K | $76.66 | 5.05x |
| 90937 | Hemodialysis procedure with repeated evaluations | 26 | $2.9K | $112.99 | 9.42x |
This provider submits charges 5.56 times higher than what Medicare actually pays.
A markup ratio of 5.56x means for every $100 Medicare pays, this provider initially charges $556. 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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