This provider's $22.4M in total Medicare payments ranks in the 99th percentile of Urology providers nationally.
Medicare payments to this provider grew 53% from 2014 to 2023.
96% 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 61% in 2019
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 | $2.7K | $1.1K | 2.52x | $1.7K | $1.4M | 2.8K | 2.0K |
| 2015 | $2.5K | $1.1K | 2.40x | $1.5K | $1.9M | 3.4K | 2.2K |
| 2016 | $2.2K | $954.02 | 2.29x | $1.2K | $1.8M | 3.7K | 2.4K |
| 2017 | $2.7K | $1.2K | 2.26x | $1.5K | $2.1M | 3.7K | 2.3K |
| 2018 | $3.3K | $1.6K | 2.05x | $1.7K | $2.0M | 2.7K | 1.9K |
| 2019 | $4.2K | $1.9K | 2.23x | $2.3K | $3.3M | 2.2K | 1.6K |
| 2020 | $4.2K | $2.0K | 2.09x | $2.2K | $2.7M | 1.7K | 1.3K |
| 2021 | $4.7K | $2.4K | 1.97x | $2.3K | $3.0M | 1.8K | 1.4K |
| 2022 | $4.7K | $2.5K | 1.86x | $2.2K | $2.2M | 1.7K | 1.3K |
| 2023 | $4.3K | $2.2K | 1.92x | $2.1K | $2.1M | 2.0K | 1.4K |
| 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 | 624 | $21.4M | $34.3K | 2.09x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 5.8K | $318.9K | $55.22 | 2.84x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 1.3K | $116.1K | $86.61 | 2.54x |
| 96413 | Infusion of chemotherapy into a vein up to 1 hour | 658 | $78.4K | $119.14 | 2.92x |
| 99215 | Established patient office or other outpatient, visit typically 40 minutes | 649 | $76.7K | $118.15 | 2.39x |
| 52000 | Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope | 660 | $54.6K | $82.78 | 4.34x |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 318 | $53.7K | $168.74 | 2.58x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 381 | $46.0K | $120.72 | 2.64x |
| 55700 | Biopsy of prostate gland | 423 | $43.7K | $103.35 | 4.38x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 239 | $19.2K | $80.33 | 2.49x |
| 81003 | Automated urinalysis test | 5.6K | $15.3K | $2.73 | 2.09x |
| 96402 | Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle | 555 | $14.2K | $25.62 | 4.34x |
| 36415 | Insertion of needle into vein for collection of blood sample | 3.9K | $13.4K | $3.44 | 2.75x |
| 51798 | Ultrasound measurement of bladder capacity after voiding | 970 | $13.1K | $13.52 | 3.24x |
| 51720 | Bladder instillation of cancer preventive, inhibiting, or suppressive agent | 152 | $12.8K | $84.30 | 2.68x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 241 | $12.8K | $52.96 | 3.13x |
| 76775 | Ultrasound behind abdominal cavity, limited | 275 | $12.5K | $45.43 | 5.08x |
| 76872 | Ultrasound of rectum | 471 | $12.4K | $26.36 | 7.21x |
| J9031 | Bcg (intravesical) per instillation | 102 | $9.9K | $96.66 | 2.37x |
| 96415 | Infusion of chemotherapy into a vein | 378 | $9.3K | $24.65 | 2.84x |
This provider submits charges 2.13 times higher than what Medicare actually pays.
A markup ratio of 2.13x means for every $100 Medicare pays, this provider initially charges $213. 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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