This provider's $8.4M in total Medicare payments ranks in the 99th 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 | $181.54 | $78.18 | 2.32x | $103.36 | $923.3K | 11.1K | 3.7K |
| 2015 | $144.20 | $76.86 | 1.88x | $67.34 | $893.9K | 11.2K | 3.5K |
| 2016 | $155.14 | $83.81 | 1.85x | $71.33 | $890.4K | 10.9K | 3.6K |
| 2017 | $154.64 | $82.40 | 1.88x | $72.24 | $866.7K | 10.5K | 3.6K |
| 2018 | $156.73 | $82.24 | 1.91x | $74.49 | $799.4K | 9.8K | 3.3K |
| 2019 | $158.94 | $84.44 | 1.88x | $74.50 | $878.6K | 10.8K | 3.7K |
| 2020 | $146.39 | $79.31 | 1.85x | $67.08 | $841.6K | 10.0K | 3.5K |
| 2021 | $268.13 | $87.87 | 3.05x | $180.26 | $826.6K | 9.4K | 3.5K |
| 2022 | $291.44 | $92.37 | 3.16x | $199.07 | $754.2K | 9.0K | 3.3K |
| 2023 | $278.19 | $91.87 | 3.03x | $186.32 | $695.9K | 8.3K | 3.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 90960 | Dialysis services (4 or more physician visits per month), patient 20 years of age and older | 10.0K | $2.1M | $212.29 | 1.85x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 30.0K | $1.6M | $52.43 | 2.00x |
| 90961 | Dialysis services (2-3 physician visits per month), patient 20 years of age and older | 7.1K | $1.3M | $180.20 | 1.89x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 21.9K | $1.2M | $53.34 | 1.90x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 6.6K | $468.5K | $70.63 | 2.05x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 5.6K | $424.7K | $76.13 | 2.08x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 3.2K | $307.5K | $95.02 | 1.87x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 2.6K | $300.0K | $113.91 | 1.86x |
| 90966 | Home dialysis services per month, patient 20 years of age or older | 1.5K | $282.3K | $189.32 | 3.42x |
| 90935 | Hemodialysis procedure with one physician evaluation | 3.6K | $187.4K | $52.34 | 2.90x |
| 90962 | Dialysis services (1 physician visit per month), patient 20 years of age and older | 684 | $92.9K | $135.86 | 1.71x |
| 90937 | Hemodialysis procedure with repeated evaluations | 672 | $50.4K | $75.06 | 4.29x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 3.2K | $43.7K | $13.68 | 2.19x |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | 2.3K | $20.6K | $9.01 | 1.89x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 579 | $16.3K | $28.09 | 2.24x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 143 | $11.5K | $80.65 | 2.11x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 326 | $10.9K | $33.42 | 2.05x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 887 | $2.2K | $2.46 | 1.64x |
| 90945 | Dialysis procedure including 1 evaluation | 32 | $2.0K | $61.30 | 3.17x |
| 99217 | Hospital observation care discharge | 35 | $1.9K | $53.45 | 5.24x |
This provider submits charges 2.01 times higher than what Medicare actually pays.
A markup ratio of 2.01x means for every $100 Medicare pays, this provider initially charges $201. 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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