This provider's $7.1M in total Medicare payments ranks in the 99th percentile of Nephrology providers nationally.
Their average markup ratio of 5.09x is significantly above the specialty median of 2.9x.
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 | $322.23 | $92.97 | 3.47x | $229.26 | $860.4K | 7.5K | 2.1K |
| 2015 | $386.39 | $107.39 | 3.60x | $279.00 | $875.7K | 7.9K | 2.1K |
| 2016 | $407.31 | $106.44 | 3.83x | $300.87 | $799.8K | 6.9K | 1.9K |
| 2017 | $435.34 | $102.40 | 4.25x | $332.94 | $829.7K | 7.1K | 2.0K |
| 2018 | $453.43 | $104.57 | 4.34x | $348.86 | $813.5K | 6.6K | 1.7K |
| 2019 | $373.99 | $103.45 | 3.62x | $270.54 | $795.8K | 6.0K | 1.6K |
| 2020 | $334.33 | $89.52 | 3.73x | $244.81 | $706.6K | 5.5K | 1.6K |
| 2021 | $393.54 | $124.58 | 3.16x | $268.96 | $594.1K | 3.6K | 1.0K |
| 2022 | $444.55 | $134.65 | 3.30x | $309.90 | $450.7K | 2.8K | 735 |
| 2023 | $409.00 | $118.61 | 3.45x | $290.39 | $327.1K | 2.2K | 609 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 90960 | Dialysis services (4 or more physician visits per month), patient 20 years of age and older | 17.4K | $3.9M | $222.64 | 3.45x |
| 90935 | Hemodialysis procedure with one physician evaluation | 17.4K | $961.7K | $55.30 | 16.28x |
| 90961 | Dialysis services (2-3 physician visits per month), patient 20 years of age and older | 5.0K | $947.7K | $190.26 | 3.02x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 4.8K | $367.1K | $77.27 | 2.59x |
| 90966 | Home dialysis services per month, patient 20 years of age or older | 1.5K | $279.0K | $186.49 | 4.04x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 2.5K | $258.4K | $102.88 | 2.92x |
| 90962 | Dialysis services (1 physician visit per month), patient 20 years of age and older | 782 | $111.5K | $142.58 | 2.58x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 574 | $86.5K | $150.72 | 1.99x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.3K | $74.1K | $55.03 | 2.73x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 286 | $33.2K | $116.00 | 3.45x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 255 | $19.8K | $77.66 | 3.12x |
| 90945 | Dialysis procedure including one evaluation | 271 | $17.0K | $62.71 | 14.35x |
| 81002 | Urinalysis, manual test | 3.7K | $12.5K | $3.42 | 7.32x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 211 | $10.5K | $49.79 | 2.41x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 83 | $6.6K | $79.40 | 2.53x |
| 99238 | Hospital discharge day management, 30 minutes or less | 19 | $1.0K | $55.05 | 3.63x |
| 90970 | Dialysis services, per day (less than full month service), patient 20 years of age or older | 144 | $980.69 | $6.81 | 5.69x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 32 | $956.33 | $29.89 | 1.34x |
| 99441 | Physician telephone patient service, 5-10 minutes of medical discussion | 17 | $506.43 | $29.79 | 1.34x |
This provider submits charges 5.09 times higher than what Medicare actually pays.
A markup ratio of 5.09x means for every $100 Medicare pays, this provider initially charges $509. 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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