This provider's $12.1M in total Medicare payments ranks in the 99th percentile of Nephrology providers nationally.
66% of their billing comes from a single procedure code (90960 — Dialysis services (4 or more physician visits per month), patient 20 years of age and older).
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 | $202.03 | $60.72 | 3.33x | $141.31 | $1.3M | 7.8K | 2.4K |
| 2015 | $275.10 | $82.26 | 3.34x | $192.84 | $1.3M | 7.5K | 2.2K |
| 2016 | $220.26 | $64.36 | 3.42x | $155.90 | $1.3M | 7.4K | 2.1K |
| 2017 | $298.79 | $83.12 | 3.59x | $215.67 | $1.2M | 7.3K | 2.0K |
| 2018 | $223.49 | $69.86 | 3.20x | $153.63 | $1.3M | 7.6K | 2.2K |
| 2019 | $230.41 | $70.44 | 3.27x | $159.97 | $1.3M | 7.8K | 2.1K |
| 2020 | $302.97 | $93.74 | 3.23x | $209.23 | $1.3M | 7.3K | 2.0K |
| 2021 | $293.08 | $105.56 | 2.78x | $187.52 | $1.3M | 6.4K | 1.7K |
| 2022 | $255.29 | $89.05 | 2.87x | $166.24 | $1.1M | 5.5K | 1.5K |
| 2023 | $243.18 | $84.05 | 2.89x | $159.13 | $847.0K | 5.1K | 1.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 90960 | Dialysis services (4 or more physician visits per month), patient 20 years of age and older | 33.8K | $7.9M | $234.93 | 2.98x |
| 90961 | Dialysis services (2-3 physician visits per month), patient 20 years of age and older | 11.5K | $2.3M | $196.57 | 3.05x |
| 90966 | Home dialysis services per month, patient 20 years of age or older | 4.5K | $896.4K | $197.97 | 3.54x |
| 90962 | Dialysis services (1 physician visit per month), patient 20 years of age and older | 3.1K | $452.2K | $144.75 | 3.80x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.2K | $85.5K | $69.11 | 2.92x |
| 90937 | Hemodialysis procedure with repeated evaluations | 886 | $72.2K | $81.45 | 4.70x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 453 | $70.8K | $156.31 | 2.24x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.2K | $67.5K | $56.81 | 3.52x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 635 | $65.9K | $103.74 | 2.83x |
| 90935 | Hemodialysis procedure with one physician evaluation | 1.1K | $60.6K | $57.00 | 4.84x |
| 90970 | Dialysis services, per day (less than full month service), patient 20 years of age or older | 9.1K | $60.3K | $6.63 | 3.77x |
| 99239 | Hospital discharge day management, more than 30 minutes | 188 | $15.6K | $83.23 | 2.70x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 398 | $15.6K | $39.13 | 3.43x |
| 90993 | Dialysis training, patient helper, course not completed | 345 | $5.4K | $15.70 | 2.87x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 26 | $3.9K | $151.24 | 2.45x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 175 | $3.2K | $18.56 | 6.43x |
| 80053 | Blood test, comprehensive group of blood chemicals | 142 | $1.6K | $10.97 | 3.04x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 17 | $1.4K | $82.34 | 3.04x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test | 143 | $1.2K | $8.33 | 2.93x |
| 83735 | Magnesium level | 144 | $1.1K | $7.65 | 2.99x |
This provider submits charges 3.09 times higher than what Medicare actually pays.
A markup ratio of 3.09x means for every $100 Medicare pays, this provider initially charges $309. 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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