Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

⚖️ Compare🖨️ Print Report

BALBOA NEPHROLOGY MEDICAL GROUP, INC.

Internal Medicine, Nephrology·SAN DIEGO, CA·NPI: 1316997505Share
Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$25.9M

$25,859,996

Total Claims

402K

Beneficiaries

297K

1.4 claims/patient

Avg Cost/Claim

$64

Monthly Spending Trend

Yearly Spending

2018
$2.9M
+8%
2019
$3.2M
+9%
2020
$3.5M
+15%
2021
$4.0M
-5%
2022
$3.8M
+10%
2023
$4.2M
-3%
2024
$4.1M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 50 distinct procedure codes. The top code (90960 (End-stage renal disease services, per month, age 20+)) accounts for 49% of total spending.

90960Top 25%

End-stage renal disease services, per month, age 20+

$12.7M

112K claims · 49.1%

Your Cost: $113.33/claim|Median: $52.76
2.1× median
99232Normal range

Subsequent hospital care, per day, moderate complexity

$2.7M

111K claims · 10.6%

Your Cost: $24.58/claim|Median: $23.99
1.0× median
36902Top 25%

$2.6M

5,219 claims · 10.2%

Your Cost: $506.07/claim|Median: $178.61
2.8× median
99214Normal range

Office/outpatient visit, est. patient, mod-high complexity

$2.2M

68K claims · 8.3%

Your Cost: $31.54/claim|Median: $53.41
0.6× median
99233Normal range

Subsequent hospital care, per day, high complexity

$1.1M

39K claims · 4.2%

Your Cost: $28.04/claim|Median: $35.30
0.8× median
36905Top 10%

$971K

891 claims · 3.8%

Your Cost: $1,089.41/claim|Median: $318.94
3.4× median
90961Top 25%

$904K

9,237 claims · 3.5%

Your Cost: $97.82/claim|Median: $47.22
2.1× median
90966Top 25%

$732K

6,291 claims · 2.8%

Your Cost: $116.36/claim|Median: $56.49
2.1× median
99223Normal range

Initial hospital care, per day, high complexity

$483K

8,985 claims · 1.9%

Your Cost: $53.72/claim|Median: $67.32
0.8× median
99213Normal range

Office/outpatient visit, est. patient, low-mod complexity

$211K

9,517 claims · 0.8%

Your Cost: $22.14/claim|Median: $37.81
0.6× median
90935Normal range

Hemodialysis, one evaluation

$192K

5,935 claims · 0.7%

Your Cost: $32.41/claim|Median: $23.72
1.4× median
36901Top 5%

$156K

575 claims · 0.6%

Your Cost: $270.48/claim|Median: $69.67
3.9× median
36215Normal range

$155K

1,404 claims · 0.6%

Your Cost: $110.70/claim|Median: $81.21
1.4× median
75710Top 25%

$144K

1,638 claims · 0.6%

Your Cost: $87.88/claim|Median: $29.01
3.0× median
99152Top 25%

$122K

6,124 claims · 0.5%

Your Cost: $19.97/claim|Median: $7.34
2.7× median
99222Normal range

Initial hospital care, per day, moderate complexity

$81K

1,716 claims · 0.3%

Your Cost: $47.44/claim|Median: $51.25
0.9× median
93985Top 25%

$77K

500 claims · 0.3%

Your Cost: $154.12/claim|Median: $87.88
1.8× median
99204Normal range

Office/outpatient visit, new patient, mod-high complexity

$73K

1,154 claims · 0.3%

Your Cost: $63.59/claim|Median: $84.03
0.8× median
36589Normal range

$50K

535 claims · 0.2%

Your Cost: $93.90/claim|Median: $74.29
1.3× median
36907Normal range

$39K

320 claims · 0.2%

Your Cost: $122.59/claim|Median: $86.23
1.4× median
99215Normal range

Office/outpatient visit, high complexity

$23K

651 claims · 0.1%

Your Cost: $35.74/claim|Median: $74.09
0.5× median
99231Normal range

Subsequent hospital care, per day, low complexity

$23K

1,939 claims · 0.1%

Your Cost: $11.73/claim|Median: $16.77
0.7× median
90962Normal range

$16K

309 claims · 0.1%

Your Cost: $53.26/claim|Median: $40.91
1.3× median
99457Normal range

$13K

1,447 claims · 0.0%

Your Cost: $8.75/claim|Median: $6.05
1.4× median
99458Normal range

$13K

1,001 claims · 0.0%

Your Cost: $12.64/claim|Median: $6.87
1.8× median
37225Normal range

$11K

12 claims · 0.0%

Your Cost: $908.31/claim|Median: $1,075.53
0.8× median
77001Top 25%

$9K

250 claims · 0.0%

Your Cost: $37.74/claim|Median: $8.60
4.4× median
G2211Normal range

$7K

2,513 claims · 0.0%

Your Cost: $2.97/claim|Median: $2.40
1.2× median
99205Normal range

Office/outpatient visit, new patient, high complexity

$7K

92 claims · 0.0%

Your Cost: $79.48/claim|Median: $111.09
0.7× median
36821Normal range

$7K

37 claims · 0.0%

Your Cost: $185.78/claim|Median: $340.50
0.5× median
99454Normal range

$6K

525 claims · 0.0%

Your Cost: $11.84/claim|Median: $9.15
1.3× median
99442Normal range

Telephone E/M by physician, 11-20 minutes

$5K

280 claims · 0.0%

Your Cost: $19.18/claim|Median: $22.44
0.9× median
99153Normal range

$3K

338 claims · 0.0%

Your Cost: $8.81/claim|Median: $5.60
1.6× median
90970Normal range

$2K

304 claims · 0.0%

Your Cost: $6.07/claim|Median: $3.56
1.7× median
36558Normal range

$1K

12 claims · 0.0%

Your Cost: $123.11/claim|Median: $112.94
1.1× median
99203Normal range

Office/outpatient visit, new patient, low-mod complexity

$1K

26 claims · 0.0%

Your Cost: $55.40/claim|Median: $57.85
1.0× median
93925Normal range

$1K

40 claims · 0.0%

Your Cost: $35.57/claim|Median: $54.12
0.7× median
J0885Normal range

$1K

73 claims · 0.0%

Your Cost: $16.91/claim|Median: $67.33
0.3× median
Q9967Normal range

Low osmolar contrast material, 300-399 mg iodine/ml, per ml

$919

299 claims · 0.0%

Your Cost: $3.07/claim|Median: $3.42
0.9× median
96372Normal range

Therapeutic injection, subcutaneous/intramuscular

$774

244 claims · 0.0%

Your Cost: $3.17/claim|Median: $9.56
0.3× median
99497Normal range

$673

62 claims · 0.0%

Your Cost: $10.86/claim|Median: $10.99
1.0× median
76937Normal range

$578

52 claims · 0.0%

Your Cost: $11.11/claim|Median: $6.99
1.6× median
75625Normal range

$546

12 claims · 0.0%

Your Cost: $45.52/claim|Median: $33.41
1.4× median
99212Normal range

Office/outpatient visit, low complexity

$454

30 claims · 0.0%

Your Cost: $15.14/claim|Median: $25.06
0.6× median
99349Normal range

$379

25 claims · 0.0%

Your Cost: $15.15/claim|Median: $24.29
0.6× median
J2250Normal range

Injection, midazolam HCl, per one milligram

$346

189 claims · 0.0%

Your Cost: $1.83/claim|Median: $0.32
5.7× median
99453Normal range

$326

129 claims · 0.0%

Your Cost: $2.53/claim|Median: $3.83
0.7× median
93923Normal range

$301

13 claims · 0.0%

Your Cost: $23.18/claim|Median: $38.08
0.6× median
0061UNormal range

$110

127 claims · 0.0%

Your Cost: $0.87/claim|Median: $0.87
1.0× median
J3010Normal range

$87

82 claims · 0.0%

Your Cost: $1.06/claim|Median: $0.55
1.9× median

Other Top Providers in California

View all →

Los Angeles County Department of Mental Health

Clinic/Center, Mental Health (Including Community

$6.78B

County of Santa Clara

Community/Behavioral Health

$1.73B

County of Riverside

Community/Behavioral Health

$1.40B

City & County of San Francisco

Community/Behavioral Health

$1.34B

Los Angeles County Department of Public Health

Public Health or Welfare

$1.13B

← All providersAll providers in California →How we detect fraud →