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Selling a Urology Practice in 2026: Multiples, Named Buyers, and the MSO Playbook

Quick Answer

A US urology practice in 2026 typically sells for roughly 6x to 12x EBITDA. Urology has been one of the more active physician-services consolidations because of in-office ancillary economics (in-office pathology, lithotripsy, radiation oncology, urology-specific imaging) and the high-margin prostate cancer treatment ecosystem. By profile: single-MD urology ($500k-1.5M EBITDA) goes 5x-7x; multi-MD single-site or 2-3 location practice ($1.5-5M EBITDA) goes 6x-9x; small regional urology group with full ancillary suite ($3-10M EBITDA) goes 7x-10x; mid-size platform ($10-30M EBITDA, multi-site, integrated radiation oncology + pathology) goes 9x-11x; premium scale platform ($30M+ EBITDA, multi-state, comprehensive prostate cancer center, advanced robotics) reaches 10x-12x+. Active buyers include US Urology Partners (NMS Capital, the largest US urology MSO with ~500+ providers), Solaris Health Holdings (Lee Equity Partners, multi-state platform), Chesapeake Urology Associates (United Urology Group, multi-state), United Urology Group (PE-backed, parent of Chesapeake), Premier Urology Group (PE-backed), Florida Urology Partners, US Oncology Network (McKesson NYSE: MCK, oncology adjacency), plus PE sponsors (NMS Capital, Lee Equity Partners, Audax Group, Frazier Healthcare Partners, Webster Equity Partners). The biggest multiple drivers are ancillary services integration (in-office pathology, lithotripsy, radiation oncology partnerships, urology-specific imaging), prostate cancer treatment ecosystem (HIFU, focal therapy, robotic prostatectomy), commercial payer mix, advanced practice provider (APP) scaling, and modern EMR. Buyer-paid M&A advisory (CT Strategic Partners) costs the seller nothing.

If you own a US urology practice in 2026, the M&A market is one of the more active physician-services consolidations. US Urology Partners (NMS Capital) leads at ~500+ providers. Solaris Health Holdings (Lee Equity Partners), Chesapeake Urology / United Urology Group, and Premier Urology Group compete. PE sponsors continue regional rollups driven by ancillary economics and prostate cancer treatment ecosystem opportunity.

What the asset is worth depends on three things: (1) ancillary services integration (in-office pathology, lithotripsy, radiation oncology partnerships, urology-specific imaging), (2) prostate cancer treatment ecosystem (HIFU / focal therapy, robotic prostatectomy, brachytherapy partnerships), and (3) commercial payer mix plus APP scaling. This guide covers real multiples by profile, the named buyers transacting, and the operator-level diligence buyers will run.

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What this guide covers

Urology multiples 2026: 5x-7x for single-MD, 6x-9x for multi-MD, 7x-10x for small regional with full ancillary, 9x-11x for mid-size platforms, 10x-12x+ for premium scale with comprehensive prostate cancer center.
Active buyers: US Urology Partners (NMS Capital, ~500+ providers, largest US urology MSO), Solaris Health Holdings (Lee Equity Partners), United Urology Group (PE-backed, parent of Chesapeake Urology), Premier Urology Group (PE), Florida Urology Partners.
PE sponsor activity: NMS Capital (US Urology Partners), Lee Equity Partners (Solaris Health), Audax Group, Frazier Healthcare Partners, Webster Equity Partners.
Multiple drivers: ancillary services integration (in-office pathology, lithotripsy, radiation oncology, urology-specific imaging), prostate cancer treatment ecosystem (HIFU, focal therapy, robotic prostatectomy, brachytherapy), commercial payer mix, APP scaling, modern EMR.
Things that compress: weak ancillary integration, owner-MD dependence, Medicare-heavy payer mix, weak prostate cancer treatment capability, Stark/anti-kickback exposure on in-office ancillaries.
Sellers pay nothing on CT Strategic Partners’ buyer-paid advisory.

Named M&A transactions (2021-2025)

Target	Buyer	Year	What it tells us
US Urology Partners continued growth	NMS Capital	2022-2025	Dominant US urology MSO continues aggressive tuck-in M&A.
Solaris Health Holdings expansion	Lee Equity Partners	2022-2025	Multi-state urology platform continues regional rollups.
United Urology Group growth	PE-backed	2022-2025	Parent of Chesapeake Urology continues expansion.
Premier Urology Group expansion	PE-backed	2022-2025	Regional urology platform continues growth.
Multiple regional urology tuck-ins	Various PE platforms	2022-2025	PE sponsors continue urology consolidation.

The named buyer landscape

PE-backed national urology MSOs

US Urology Partners (NMS Capital) — ~500+ providers, the largest US urology MSO.
Solaris Health Holdings (Lee Equity Partners) — multi-state platform.
United Urology Group (PE-backed) — parent of Chesapeake Urology.
Premier Urology Group (PE-backed).
Chesapeake Urology Associates (United Urology Group subsidiary).
Florida Urology Partners.

Oncology-adjacent acquirers

US Oncology Network (McKesson NYSE: MCK) — selective urology acquirer for oncology adjacency.

PE sponsors active in this space

NMS Capital (US Urology Partners), Lee Equity Partners (Solaris Health Holdings), Audax Group, Frazier Healthcare Partners, Webster Equity Partners.

What each buyer will pay for vs. what they reject

Will pay premium for: ancillary services integration (in-office pathology with Stark-compliant structure, lithotripsy units, radiation oncology partnerships or ownership, urology-specific imaging including bladder ultrasound and prostate MRI), prostate cancer treatment ecosystem (HIFU, focal therapy, robotic prostatectomy capability with da Vinci or Hugo, brachytherapy partnerships), advanced practice provider scaling, commercial payer mix 55%+, modern EMR (Modernizing Medicine EMA-Uro, Provation, Athenahealth).
Will compress or reject: weak ancillary integration, owner-MD dependence, Medicare-heavy payer mix above 60%, weak prostate cancer treatment capability, Stark or anti-kickback exposure on in-office ancillaries, single-state, weak APP scaling.

The operator-level KPI playbook buyers will diligence

Procedural and case mix

Office visit volume (BPH, prostate, OAB, stones).
Cystoscopy and in-office procedure volume.
Prostate biopsy volume.
Lithotripsy (ESWL) volume.
Robotic prostatectomy / cystectomy volume.
HIFU and focal therapy volume.

Ancillary services

In-office pathology with Stark-compliant structure.
Lithotripsy unit ownership.
Radiation oncology ownership or partnership (LDR/HDR brachytherapy, IMRT, SBRT).
Urology-specific imaging (bladder ultrasound, prostate MRI, UroNav fusion).
Allergy testing in some practices.

Payer mix

Commercial percentage: 55%+ benchmark.
Medicare percentage: 35-50% typical.
Value-based-care contracts.

Provider bench

MD count and subspecialty (general uro, urologic oncology, female pelvic medicine, pediatric uro, andrology, endourology, transplant).
APP scaling (NPs and PAs are heavily scaled in urology).
Equity-rollover expectations (PE-MSO urology deals typically 30-50% rollover).

Dangers and traps

1. Stark and anti-kickback exposure on in-office ancillaries

Pathology, radiation oncology, lithotripsy must be Stark-compliant.

2. Weak ancillary integration

Pathology, lithotripsy, radiation oncology, imaging are major multiple-builders.

3. Owner-MD dependence

Build MD/APP bench.

4. Medicare-heavy payer mix

Above 60% Medicare compresses.

5. Weak prostate cancer treatment capability

HIFU, focal therapy, robotic capability are premium revenue.

6. Single-state operations

Multi-state path matters.

7. Weak APP scaling

APP scaling is critical in urology operating economics.

8. Equity rollover expectations

PE-MSO urology deals typically 30-50% rollover.

Our POV in 2026

Urology M&A has been one of the most active physician-services consolidations. US Urology Partners (NMS Capital) leads at ~500+ providers. Solaris Health Holdings (Lee Equity Partners), United Urology Group, and Premier Urology Group compete. Ancillary economics (pathology, lithotripsy, radiation oncology) and prostate cancer treatment ecosystem drive multiples.

The right time to prepare is 12-18 months before going to market — integrate ancillaries, build prostate cancer treatment capability, scale APPs.

Preparing your business for sale: 12-18 months out

Get multi-year audited financials.
Integrate ancillaries (Stark-compliant in-office pathology, lithotripsy, radiation oncology partnerships).
Build prostate cancer treatment ecosystem (HIFU, focal therapy, robotic capability).
Scale APPs.
Confirm commercial in-network status.
Modernize EMR.
Build the MD bench across subspecialties.
Document add-backs.
Run a competitive process. US Urology Partners (NMS Capital), Solaris Health (Lee Equity Partners), United Urology Group, Chesapeake Urology, Premier Urology Group, Florida Urology Partners, plus PE sponsors directly (NMS Capital, Lee Equity Partners, Audax Group, Frazier Healthcare Partners, Webster Equity Partners).

About the Author

Christoph Totter is the founder of CT Acquisitions, a buy-side partner headquartered in Sheridan, Wyoming. We work directly with 76+ buyers, search funders, family offices, lower middle-market PE, and strategic consolidators, including direct mandates with the largest home services consolidators that other intermediaries can’t access. The buyers pay us when a deal closes, not the seller. No retainer, no exclusivity, no contract until close. Connect on LinkedIn · Get in touch

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Frequently asked questions

What is the typical multiple for a urology practice in 2026?

Single-MD urology practices ($500k-1.5M EBITDA) typically sell at 5x-7x EBITDA. Multi-MD single-site or 2-3 location practices ($1.5-5M EBITDA) go 6x-9x. Small regional urology groups with full ancillary suite ($3-10M EBITDA) go 7x-10x. Mid-size platforms ($10-30M EBITDA, multi-site, integrated radiation oncology + pathology) go 9x-11x. Premium scale platforms ($30M+ EBITDA, multi-state, comprehensive prostate cancer center, advanced robotics) reach 10x-12x+.

Who are the active buyers of urology practices right now?

PE-backed national urology MSOs: US Urology Partners (NMS Capital, ~500+ providers, largest US urology MSO), Solaris Health Holdings (Lee Equity Partners), United Urology Group (PE-backed, parent of Chesapeake Urology Associates), Premier Urology Group (PE), Florida Urology Partners. Oncology-adjacent: US Oncology Network (McKesson NYSE: MCK). PE sponsors: NMS Capital, Lee Equity Partners, Audax Group, Frazier Healthcare Partners, Webster Equity Partners.

What hurts a urology practice’s valuation most?

Weak ancillary integration (pathology, lithotripsy, radiation oncology, imaging are major multiple-builders), owner-MD dependence, Medicare-heavy payer mix, weak prostate cancer treatment capability, Stark or anti-kickback exposure on in-office ancillaries, single-state operations, and weak APP scaling.

Why is ancillary integration so important in urology?

Urology has unusually rich in-office ancillary opportunities: in-office pathology (prostate biopsies, bladder washings), lithotripsy units (kidney stones), radiation oncology partnerships or ownership (prostate cancer brachytherapy, IMRT, SBRT), urology-specific imaging (bladder ultrasound, prostate MRI, UroNav fusion biopsy), and allergy testing in some practices. Each ancillary requires Stark-compliant structure. Urology platforms with full ancillary integration achieve 2-4 turns of EBITDA multiple premium.

Do I have to pay a broker fee?

No. CT Strategic Partners runs a buyer-paid M&A advisory model. The seller pays nothing.

How long does it take to sell a urology practice?

Typical process 5-9 months. Add 12-18 months of preparation.

What is the typical equity rollover in a urology MSO transaction?

PE-MSO urology deals typically include 30-50% equity rollover for selling MDs.

When should I start preparing if I plan to sell in 2027 or 2028?

12-18 months before going to market. Highest-leverage work: integrate ancillaries, build prostate cancer treatment capability, scale APPs, develop value-based-care positioning.