This provider's $3.4M in total Medicare payments ranks in the 97th 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 | $312.33 | $110.95 | 2.82x | $201.38 | $417.8K | 3.5K | 1.8K |
| 2015 | $303.33 | $101.62 | 2.98x | $201.71 | $421.6K | 3.8K | 2.1K |
| 2016 | $334.72 | $103.28 | 3.24x | $231.44 | $374.9K | 3.5K | 1.9K |
| 2017 | $348.18 | $106.34 | 3.27x | $241.84 | $348.1K | 3.6K | 1.9K |
| 2018 | $283.93 | $92.16 | 3.08x | $191.77 | $367.0K | 3.5K | 1.9K |
| 2019 | $356.85 | $105.12 | 3.39x | $251.73 | $293.8K | 2.4K | 1.3K |
| 2020 | $400.00 | $117.55 | 3.40x | $282.45 | $274.3K | 2.0K | 1.0K |
| 2021 | $373.84 | $127.81 | 2.92x | $246.03 | $352.8K | 2.4K | 1.2K |
| 2022 | $448.57 | $140.24 | 3.20x | $308.33 | $267.4K | 1.7K | 756 |
| 2023 | $381.50 | $124.79 | 3.06x | $256.71 | $258.6K | 1.6K | 699 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 90960 | Dialysis services (4 or more physician visits per month), patient 20 years of age and older | 6.7K | $1.5M | $223.16 | 4.42x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 8.2K | $627.1K | $76.67 | 2.15x |
| 90966 | Home dialysis services per month, patient 20 years of age or older | 1.9K | $367.7K | $198.20 | 4.03x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 4.0K | $176.2K | $44.52 | 2.38x |
| 90961 | Dialysis services (2-3 physician visits per month), patient 20 years of age and older | 872 | $166.4K | $190.87 | 3.85x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.0K | $114.4K | $111.35 | 2.01x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 722 | $109.5K | $151.59 | 1.89x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.4K | $108.8K | $78.52 | 2.36x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.5K | $80.0K | $54.09 | 2.29x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 575 | $58.6K | $101.88 | 1.92x |
| 90935 | Hemodialysis procedure with one physician evaluation | 605 | $32.6K | $53.86 | 2.13x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 221 | $15.8K | $71.58 | 2.10x |
| 90962 | Dialysis services (1 physician visit per month), patient 20 years of age and older | 77 | $10.2K | $132.57 | 3.77x |
| 90937 | Hemodialysis procedure with repeated evaluations | 25 | $1.9K | $77.22 | 2.59x |
| 90970 | Dialysis services, per day (less than full month service), patient 20 years of age or older | 179 | $1.3K | $7.02 | 3.56x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 12 | $949.12 | $79.09 | 3.30x |
This provider submits charges 3.46 times higher than what Medicare actually pays.
A markup ratio of 3.46x means for every $100 Medicare pays, this provider initially charges $346. 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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