This provider's $13.7M in total Medicare payments ranks in the 99th percentile of Urology providers nationally.
78% of their billing comes from a single procedure code (Q2043 — Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 52% in 2015
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 | $1.9K | $702.34 | 2.74x | $1.2K | $974.3K | 7.2K | 5.0K |
| 2015 | $1.8K | $722.76 | 2.54x | $1.1K | $1.5M | 7.8K | 5.0K |
| 2016 | $1.8K | $732.77 | 2.52x | $1.1K | $1.3M | 8.1K | 4.8K |
| 2017 | $2.0K | $776.23 | 2.52x | $1.2K | $1.4M | 10.6K | 6.2K |
| 2018 | $1.8K | $748.80 | 2.37x | $1.0K | $1.4M | 11.3K | 6.8K |
| 2019 | $1.9K | $859.83 | 2.19x | $1.0K | $1.4M | 10.9K | 6.7K |
| 2020 | $1.7K | $860.21 | 2.01x | $870.24 | $1.4M | 10.4K | 6.6K |
| 2021 | $1.8K | $909.12 | 1.99x | $899.46 | $1.7M | 11.6K | 7.4K |
| 2022 | $2.0K | $988.50 | 2.01x | $997.60 | $2.0M | 12.4K | 7.5K |
| 2023 | $472.86 | $76.31 | 6.20x | $396.55 | $482.6K | 14.3K | 8.3K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| Q2043 | Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion | 309 | $10.3M | $33.4K | 1.79x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 14.9K | $1.1M | $76.20 | 2.49x |
| 84153 | PSA (prostate specific antigen) measurement | 11.6K | $234.3K | $20.22 | 3.71x |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 1.3K | $211.9K | $159.57 | 5.64x |
| 74178 | CT scan of abdomen and pelvis before and after contrast | 815 | $199.7K | $245.03 | 7.45x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 1.9K | $199.5K | $107.28 | 2.80x |
| 74176 | CT scan of abdomen and pelvis | 816 | $105.4K | $129.19 | 8.44x |
| 52000 | Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope | 1.4K | $97.7K | $67.91 | 7.36x |
| 55866 | Surgical removal of prostate and surrounding lymph nodes using an endoscope | 174 | $93.5K | $537.38 | 8.98x |
| 82570 | Creatinine level to test for kidney function or muscle injury | 15.6K | $91.1K | $5.82 | 3.44x |
| 52601 | Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope | 120 | $68.1K | $567.53 | 3.52x |
| 52356 | Crushing of stone in urinary duct (ureter) with stent using an endoscope | 213 | $66.9K | $313.87 | 12.22x |
| 84403 | Testosterone (hormone) level | 2.3K | $60.4K | $26.43 | 5.30x |
| 50590 | Shock wave crushing of kidney stones | 132 | $56.3K | $426.40 | 5.48x |
| 81001 | Manual urinalysis test with examination using microscope | 15.7K | $55.8K | $3.56 | 3.93x |
| 36415 | Insertion of needle into vein for collection of blood sample | 13.6K | $49.8K | $3.67 | 5.45x |
| 96372 | Injection beneath the skin or into muscle for therapy, diagnosis, or prevention | 3.5K | $48.7K | $13.99 | 3.00x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 1.5K | $40.1K | $26.81 | 3.17x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 825 | $38.3K | $46.38 | 3.23x |
| 96402 | Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle | 1.5K | $35.3K | $23.39 | 4.02x |
This provider submits charges 2.43 times higher than what Medicare actually pays.
A markup ratio of 2.43x means for every $100 Medicare pays, this provider initially charges $243. 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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