This provider's $3.9M in total Medicare payments ranks in the 98th percentile of Nephrology providers nationally.
70% 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 | $307.32 | $113.21 | 2.71x | $194.11 | $432.1K | 2.7K | 940 |
| 2015 | $271.98 | $94.50 | 2.88x | $177.48 | $356.0K | 2.4K | 887 |
| 2016 | $292.86 | $107.30 | 2.73x | $185.56 | $261.5K | 1.7K | 657 |
| 2017 | $324.20 | $116.38 | 2.79x | $207.82 | $358.9K | 2.1K | 754 |
| 2018 | $301.95 | $115.79 | 2.61x | $186.16 | $420.2K | 2.2K | 635 |
| 2019 | $323.25 | $120.82 | 2.68x | $202.43 | $441.6K | 2.3K | 653 |
| 2020 | $397.36 | $133.22 | 2.98x | $264.14 | $402.2K | 2.1K | 584 |
| 2021 | $418.37 | $131.08 | 3.19x | $287.29 | $436.5K | 1.9K | 515 |
| 2022 | $428.40 | $133.12 | 3.22x | $295.28 | $415.9K | 1.8K | 429 |
| 2023 | $730.50 | $218.44 | 3.34x | $512.06 | $403.6K | 1.6K | 382 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 90960 | Dialysis services (4 or more physician visits per month), patient 20 years of age and older | 11.7K | $2.8M | $234.98 | 2.85x |
| 90961 | Dialysis services (2-3 physician visits per month), patient 20 years of age and older | 3.3K | $640.0K | $194.36 | 2.81x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 2.2K | $165.5K | $75.84 | 2.86x |
| 90962 | Dialysis services (1 physician visit per month), patient 20 years of age and older | 717 | $104.5K | $145.69 | 3.01x |
| 90966 | Home dialysis services per month, patient 20 years of age or older | 467 | $96.1K | $205.86 | 3.03x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.0K | $84.6K | $80.85 | 2.75x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 447 | $25.3K | $56.55 | 2.74x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 203 | $21.0K | $103.57 | 2.81x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 422 | $17.9K | $42.46 | 3.73x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 108 | $12.9K | $119.04 | 2.77x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 62 | $2.3K | $36.39 | 2.75x |
| 90935 | Hemodialysis procedure with one physician evaluation | 21 | $1.2K | $57.54 | 4.36x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 32 | $963.52 | $30.11 | 4.38x |
| 99439 | Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month | 15 | $469.13 | $31.28 | 1.71x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 15 | $293.75 | $19.58 | 4.53x |
| 90970 | Dialysis services, per day (less than full month service), patient 20 years of age or older | 19 | $115.78 | $6.09 | 2.63x |
This provider submits charges 2.85 times higher than what Medicare actually pays.
A markup ratio of 2.85x means for every $100 Medicare pays, this provider initially charges $285. 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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