This provider's $4.5M in total Medicare payments ranks in the 98th percentile of Urology 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 | $283.54 | $103.45 | 2.74x | $180.09 | $373.4K | 5.8K | 3.3K |
| 2015 | $272.13 | $95.70 | 2.84x | $176.43 | $377.7K | 6.1K | 3.7K |
| 2016 | $255.11 | $88.12 | 2.90x | $166.99 | $422.3K | 7.7K | 4.8K |
| 2017 | $303.84 | $121.50 | 2.50x | $182.34 | $493.1K | 8.3K | 5.1K |
| 2018 | $827.70 | $202.48 | 4.09x | $625.22 | $558.4K | 7.8K | 4.9K |
| 2019 | $987.41 | $221.38 | 4.46x | $766.03 | $595.7K | 7.1K | 4.5K |
| 2020 | $555.04 | $114.79 | 4.84x | $440.25 | $405.4K | 7.1K | 4.3K |
| 2021 | $455.35 | $107.82 | 4.22x | $347.53 | $409.0K | 8.1K | 4.5K |
| 2022 | $567.59 | $95.05 | 5.97x | $472.54 | $399.4K | 7.5K | 5.0K |
| 2023 | $1.4K | $179.43 | 8.05x | $1.3K | $418.4K | 6.0K | 4.0K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 15.3K | $1.3M | $87.43 | 2.59x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 9.8K | $623.0K | $63.78 | 3.18x |
| 52000 | Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope | 1.8K | $310.4K | $173.59 | 3.28x |
| 55874 | Injection of biodegradable material next to prostate | 73 | $225.5K | $3.1K | 4.95x |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 1.3K | $210.5K | $162.93 | 4.36x |
| 52224 | Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope | 226 | $139.6K | $617.66 | 3.91x |
| 76872 | Ultrasound of rectum | 1.3K | $136.7K | $101.36 | 3.29x |
| 55700 | Biopsy of prostate gland | 614 | $124.2K | $202.21 | 3.99x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 813 | $104.3K | $128.33 | 2.86x |
| 51728 | Insertion of electronic device into bladder with voiding pressure studies | 262 | $75.9K | $289.59 | 3.08x |
| G9678 | Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation | 447 | $70.1K | $156.80 | 1.02x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 604 | $66.3K | $109.72 | 2.31x |
| 52441 | Insertion of implant material in bladder using an endoscope | 58 | $64.8K | $1.1K | 2.88x |
| 51798 | Ultrasound measurement of bladder capacity after voiding | 4.7K | $62.2K | $13.20 | 4.18x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 908 | $60.4K | $66.47 | 3.27x |
| A4648 | Tissue marker, implantable, any type, each | 193 | $51.0K | $264.26 | 6.69x |
| 52442 | Insertion of implant material in bladder using an endoscope | 58 | $49.9K | $860.52 | 3.00x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 414 | $48.6K | $117.39 | 2.04x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 549 | $48.5K | $88.42 | 3.28x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 1.3K | $45.3K | $34.72 | 1.54x |
This provider submits charges 3.39 times higher than what Medicare actually pays.
A markup ratio of 3.39x means for every $100 Medicare pays, this provider initially charges $339. 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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