This provider's $5.8M in total Medicare payments ranks in the 99th percentile of Urology providers nationally.
65% 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 306% in 2016
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 | $637.71 | $132.56 | 4.81x | $505.15 | $173.1K | 3.8K | 2.6K |
| 2015 | $568.06 | $121.27 | 4.68x | $446.79 | $181.9K | 3.7K | 2.8K |
| 2016 | $1.7K | $722.30 | 2.37x | $988.96 | $738.6K | 4.4K | 3.1K |
| 2017 | $1.6K | $717.43 | 2.27x | $909.34 | $813.4K | 5.0K | 3.8K |
| 2018 | $1.9K | $783.78 | 2.44x | $1.1K | $1.0M | 5.0K | 3.5K |
| 2019 | $2.2K | $948.13 | 2.29x | $1.2K | $1.3M | 5.5K | 4.1K |
| 2020 | $2.5K | $866.87 | 2.87x | $1.6K | $932.7K | 4.9K | 3.8K |
| 2021 | $533.45 | $130.32 | 4.09x | $403.13 | $282.7K | 4.8K | 3.7K |
| 2022 | $418.71 | $119.97 | 3.49x | $298.74 | $245.8K | 4.1K | 3.0K |
| 2023 | $241.15 | $68.03 | 3.54x | $173.12 | $189.1K | 3.4K | 2.6K |
| 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 | 114 | $3.5M | $30.9K | 2.09x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 4.9K | $392.6K | $80.32 | 2.85x |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 1.2K | $180.5K | $156.44 | 5.67x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 3.3K | $173.2K | $52.18 | 2.93x |
| 50543 | Partial removal of kidney using an endoscope | 109 | $130.7K | $1.2K | 3.60x |
| 50547 | Removal of kidney from living donor using an endoscope | 97 | $129.1K | $1.3K | 3.71x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 1.1K | $128.2K | $114.64 | 2.67x |
| 52000 | Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope | 781 | $119.8K | $153.41 | 3.13x |
| 52310 | Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope | 435 | $85.5K | $196.44 | 3.21x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 686 | $76.8K | $111.89 | 3.14x |
| 84153 | PSA (prostate specific antigen) measurement | 3.1K | $65.2K | $20.79 | 3.37x |
| 99490 | Chronic care management services at least 20 minutes per calendar month | 1.7K | $64.5K | $37.54 | 1.90x |
| 50545 | Removal of kidney and lymph nodes using an endoscope | 48 | $48.0K | $1.0K | 4.82x |
| 96402 | Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle | 2.0K | $46.1K | $23.42 | 5.25x |
| 55866 | Surgical removal of prostate and surrounding lymph nodes using an endoscope | 38 | $44.4K | $1.2K | 3.60x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 786 | $43.8K | $55.75 | 2.59x |
| 55700 | Biopsy of prostate gland | 238 | $40.9K | $172.01 | 3.00x |
| 50360 | Transplantation of donor kidney | 82 | $39.5K | $481.13 | 11.84x |
| 52332 | Insertion of stent in urinary duct (ureter) using an endoscope | 358 | $34.0K | $94.86 | 8.70x |
| 51720 | Bladder instillation of cancer preventive, inhibiting, or suppressive agent | 497 | $33.8K | $67.97 | 4.00x |
This provider submits charges 2.73 times higher than what Medicare actually pays.
A markup ratio of 2.73x means for every $100 Medicare pays, this provider initially charges $273. 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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