Ralph Highshaw, MD
Urology · Palm Coast, FLNPI 1386726453
Payments from drug & device makers
What this record shows
This record is dominated by education: $32,347 of the $38,129 with a category attached, or 84.8%. Intuitive Surgical accounts for 86.6% of it on its own, with 26 other manufacturers making up the rest. Reporting peaked in 2020 at $25,606 and has fallen 89.7% since, to $2,641 in 2025. Among urology clinicians in FL with any reported payments, this total sits in the top 10% — high for the specialty, which is a reason to read the composition above rather than the number alone.
Across 134 payments — averaging $284.54 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Intuitive Surgical$33K
- Boston Scientific$2K
- Procept Biorobotics Corporation$907
- Medtronic$506
- Myriad Genetic Laboratories, Inc.$220
- Johnson & Johnson$153
- plus $1K from 21 others
What the payments were for
- Travel & lodging$1,8165%
- Food & beverage$3,96610%
- Education$32,34785%
General payments by program year
Who reported the general payments
Companies are grouped under their corporate parent — a single manufacturer often files under several CMS reporting entities. Research and ownership payments are counted separately and are not in this table.
| Company | Payments | Total |
|---|---|---|
| Intuitive Surgical | 25 | $33,026 |
| Boston Scientific | 24 | $2,149 |
| Procept Biorobotics Corporation | 9 | $907 |
| Medtronic(2 entities) | 10 | $506 |
| Myriad Genetic Laboratories, Inc. | 11 | $220 |
| Johnson & Johnson(2 entities) | 6 | $153 |
| Teleflex LLC | 5 | $144 |
| Travere Therapeutics, Inc. | 7 | $136 |
| Endo Pharmaceuticals Inc. | 5 | $114 |
| Ferring Pharmaceuticals Inc. | 3 | $92 |
| Coloplast | 5 | $91 |
| Smith+Nephew | 2 | $90 |
| Baxter Healthcare | 1 | $87 |
| AbbVie(2 entities) | 5 | $87 |
| Telix Pharmaceuticals | 2 | $46 |
| Neotract Inc. | 2 | $39 |
| Tolmar, Inc. | 2 | $35 |
| Blue Earth Diagnostics | 1 | $31 |
| Ambu Inc. | 1 | $26 |
| Novartis | 1 | $21 |
| Dendreon Pharmaceuticals LLC | 1 | $21 |
| Endo USA, Inc. | 1 | $19 |
| Immunitybio, Inc. | 1 | $19 |
| Davol Inc. | 1 | $19 |
| Myovant Sciences Inc. | 1 | $19 |
| Bayer | 1 | $18 |
| AstraZeneca | 1 | $13 |
What the payments were tied to
Products named in the reported payments. Only payments of $100 or more are attributed here — the typical reported payment nationally is a meal worth about $16, and listing those product-by-product would be noise.
- Da Vinci Surgical System$31,311
- DAVINCI XI$1,500
- AMS$891
- AquaBeam Robotic System$518
- AQUABEAM SYSTEM$280
- LithoVue$247
- INTERSTIM$187
- INTERSTIM ICON$121
- AMS 700$110
How this compares
$38,129 in reported general payments places this provider in the 90th percentile of 935 urology providers in Florida.
Medicare billing
What this is not: this is the amount Original Medicare Part B allowed for services this provider billed in 2024. It is not their income. It excludes Medicare Advantage — now more than half of all Medicare enrollment — along with Medicaid and all commercial insurance, and it is gross practice revenue before staff, rent, supplies and malpractice premiums. CMS also suppresses any figure covering ten or fewer patients, so low-volume providers appear smaller than they are.
Most prescribed under Part D
| Drug | Claims | Cost to plans & patients |
|---|---|---|
| Tamsulosin Hcl | 204 | $2,851 |
| Oxybutynin Chloride | 13 | $304 |
| Sulfamethoxazole-TrimethoprimSulfamethoxazole/Trimethoprim | 81 | $299 |
| Sildenafil Citrate | 16 | $167 |
Paid to pharmacies, not to this prescriber.
Other urology in Palm Coast
- Jeffrey DannPalm Coast$112K
- Paul PeritoCoral Gables$3.6M
- Scott SellingerTallahassee$2.3M
- Mark Anthony GonzalgoMiami$1M
- Edward GheilerHialeah$655K
- Rolando RiveraNaples$437K
- Matthew ErcolaniVenice$416K
- Olubayo TojuolaOrlando$283K
- Juan SuarezCoral Gables$276K
- Michael McDonaldCelebration$272K
Where these figures come from
- Payments: CMS Open Payments, program years 2019–2025 (publication P06302026_06032026).
- Billing: Medicare Physician & Other Practitioners, data year 2024. Original Medicare Part B only.
- Identity: NPPES NPI Registry, July 2026.