This provider's $3.2M 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 | $242.39 | $80.79 | 3.00x | $161.60 | $256.7K | 5.4K | 3.5K |
| 2015 | $247.42 | $73.69 | 3.36x | $173.73 | $259.5K | 5.4K | 3.6K |
| 2016 | $219.21 | $66.79 | 3.28x | $152.42 | $273.2K | 5.8K | 4.0K |
| 2017 | $238.06 | $75.85 | 3.14x | $162.21 | $286.5K | 5.9K | 4.2K |
| 2018 | $808.50 | $183.48 | 4.41x | $625.02 | $361.0K | 6.3K | 4.3K |
| 2019 | $887.38 | $192.47 | 4.61x | $694.91 | $437.8K | 5.8K | 3.9K |
| 2020 | $335.10 | $72.42 | 4.63x | $262.68 | $277.3K | 5.2K | 3.5K |
| 2021 | $366.85 | $85.57 | 4.29x | $281.28 | $343.2K | 6.3K | 4.2K |
| 2022 | $1.1K | $162.34 | 7.06x | $983.58 | $398.0K | 6.0K | 4.1K |
| 2023 | $1.2K | $159.31 | 7.30x | $1.0K | $352.4K | 5.7K | 3.9K |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 11.0K | $664.9K | $60.66 | 2.71x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 7.2K | $651.7K | $89.96 | 2.88x |
| 52000 | Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope | 2.4K | $408.2K | $168.55 | 3.33x |
| 55874 | Injection of biodegradable material next to prostate | 95 | $277.9K | $2.9K | 6.20x |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 1.2K | $198.8K | $162.59 | 4.29x |
| 55700 | Biopsy of prostate gland | 440 | $88.3K | $200.71 | 3.95x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 1.0K | $85.9K | $83.64 | 2.88x |
| 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 | 509 | $79.8K | $156.80 | 1.02x |
| 99221 | Initial hospital inpatient care, typically 30 minutes per day | 874 | $72.9K | $83.45 | 2.50x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 2.2K | $71.8K | $32.67 | 2.75x |
| 76872 | Ultrasound of rectum | 538 | $55.5K | $103.08 | 3.23x |
| 51798 | Ultrasound measurement of bladder capacity after voiding | 4.2K | $54.8K | $12.95 | 4.35x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 411 | $53.2K | $129.40 | 3.00x |
| A4648 | Tissue marker, implantable, any type, each | 120 | $39.0K | $325.13 | 6.98x |
| 81003 | Automated urinalysis test | 14.7K | $38.5K | $2.61 | 3.83x |
| 52332 | Insertion of stent in urinary duct (ureter) using an endoscope | 306 | $35.6K | $116.48 | 12.28x |
| 96402 | Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle | 1.3K | $35.6K | $26.71 | 3.72x |
| 51702 | Insertion of indwelling bladder catheter | 569 | $30.3K | $53.25 | 4.46x |
| 51720 | Bladder instillation of cancer preventive, inhibiting, or suppressive agent | 387 | $30.3K | $78.19 | 5.19x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 415 | $27.2K | $65.57 | 3.80x |
This provider submits charges 3.56 times higher than what Medicare actually pays.
A markup ratio of 3.56x means for every $100 Medicare pays, this provider initially charges $356. 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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