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adiologists. Operating room use and anesthesia services were major drivers of higher cost, with 407% (95% confidence interval 374%, 443%; P less then .001) and 132% (95% confidence interval 116%, 150%; P less then .001) higher costs, respectively. Conclusion Patency-adjusted payments for hemodialysis access maintenance differed by physician specialty, driven partly by discrepant rates of billing for operating room and anesthesia use. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by White in this issu