This provider's $3.7M in total Medicare payments ranks in the 99th percentile of Thoracic Surgery providers nationally.
This provider's billing patterns fall within normal ranges for their specialty.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 76% in 2018
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 | $4.6K | $1.1K | 4.39x | $3.6K | $526.9K | 410 | 407 |
| 2015 | $5.9K | $1.3K | 4.59x | $4.6K | $528.2K | 399 | 399 |
| 2016 | $5.8K | $1.2K | 4.79x | $4.6K | $379.0K | 286 | 284 |
| 2017 | $10.5K | $1.5K | 6.92x | $9.0K | $168.3K | 104 | 104 |
| 2018 | $7.2K | $998.45 | 7.19x | $6.2K | $295.9K | 226 | 226 |
| 2019 | $3.6K | $744.32 | 4.79x | $2.8K | $370.9K | 491 | 485 |
| 2020 | $6.4K | $1.3K | 4.84x | $5.1K | $267.6K | 210 | 203 |
| 2021 | $4.5K | $923.47 | 4.86x | $3.6K | $363.5K | 483 | 473 |
| 2022 | $3.7K | $766.96 | 4.80x | $2.9K | $418.1K | 648 | 639 |
| 2023 | $4.8K | $895.49 | 5.34x | $3.9K | $401.4K | 564 | 563 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 33405 | Replacement of left lower heart chamber valve using artificial valve on heart-lung machine | 578 | $1.1M | $2.0K | 5.06x |
| 33430 | Replacement of valve between left upper and lower chambers on heart-lung machine | 293 | $782.6K | $2.7K | 4.68x |
| 33427 | Repair of valve flaps between left heart chambers on heart-lung machine | 189 | $412.5K | $2.2K | 5.16x |
| 33533 | Heart artery bypass to repair one artery | 274 | $400.7K | $1.5K | 5.70x |
| 33426 | Insertion of artificial valve between left heart chambers on heart-lung machine | 138 | $273.7K | $2.0K | 5.23x |
| 33464 | Repair of heart valve between right chambers with insertion of prosthetic valve ring | 115 | $211.8K | $1.8K | 5.91x |
| 99205 | New patient office or other outpatient visit, typically 60 minutes | 540 | $97.6K | $180.80 | 3.65x |
| 33425 | Repair of valve between left heart chambers on heart-lung machine | 24 | $64.1K | $2.7K | 4.16x |
| 33259 | Destruction of tissue and reconstruction of right upper heart on heart-lung machine | 77 | $61.0K | $792.48 | 4.95x |
| 33530 | Reoperation of heart artery bypass or valve procedure more than 1 month after original operation | 115 | $58.4K | $507.40 | 4.60x |
| 33518 | Combined multiple vein and artery heart artery bypasses | 107 | $42.8K | $399.62 | 4.58x |
| 33257 | Destruction and reconstruction of right upper heart | 70 | $40.3K | $575.42 | 4.14x |
| 99204 | New patient office or other outpatient visit, typically 45 minutes | 271 | $38.3K | $141.36 | 3.64x |
| 99203 | New patient office or other outpatient visit, typically 30 minutes | 292 | $27.1K | $92.85 | 3.27x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 170 | $15.6K | $92.03 | 3.50x |
| 99215 | Established patient outpatient visit, total time 40-54 minutes | 91 | $13.4K | $147.23 | 2.91x |
| 33416 | Removal of thickened heart muscle at left lower heart chamber | 11 | $11.1K | $1.0K | 8.18x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 104 | $9.3K | $89.85 | 4.44x |
| 99202 | New patient office or other outpatient visit, typically 20 minutes | 107 | $6.9K | $64.07 | 3.00x |
| 99213 | Established patient office or other outpatient visit, typically 15 minutes | 71 | $5.2K | $73.02 | 2.72x |
This provider submits charges 5 times higher than what Medicare actually pays.
A markup ratio of 5x means for every $100 Medicare pays, this provider initially charges $500. 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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