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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS
19342 Placement of implant on separate day of breast reconstruction CPT · Breast procedure
Classification Procedure Breast Mastectomy (CMS RBCS)
First observed 2013 — start of our 12-year window; the code predates it
National scale 701 services ▲ 1.7% YoY · 625 beneficiaries (CY2024, Medicare FFS)
Medicare paid $673K · $959.56 avg / service, national
CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window
Billing groups
21
Named-group FFS services
349
FFS of Medicare
49%
Services YoY
+1.7%
FFS enrollment -2.2%
Estimated all-Medicare volume FFS + estimated MA estimate
~722 services

349 observed fee-for-service (48%) · ~373 estimated Medicare Advantage. Scaled from the observed floor by each state’s fee-for-service share (FFS share as of 2024) — scaled estimate — assumes MA utilization mirrors FFS; not an observation. How we scale

Top states — 19342 (CY2024)

Disclosed Medicare fee-for-service services by billing state; open a bar for that state's ranked market.

Named-group submitted charges
$2.0M
Named-group allowed amount
$269K
Named-group Medicare payments
$213K
Avg charge / svc
$5,856
Avg allowed / svc
$771
Avg payment / svc
$611
Average charge per group
$1,345 21 groups · avg submitted charge / service $25,000
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Data year: CY2024 CY2023 CY2022 locked column CY2021 locked column CY2020 locked column
Physician groups ranked by 19342 services, highest first, CY2024
# Physician group activate to sort City activate to sort St activate to sort Specialty activate to sort Providers activate to sort 19342 svcs sorted descending — activate to reverse Submitted charges activate to sort Avg charge activate to sort Medicare $ locked column Share* activate to sort Phone
1 HEALTH FIRST MEDICAL GROUP, LLC MELBOURNE FL NURSE PRACTITIONER 669 31 $41,707 $1,345 premium 19.6% (321) 434-8878
2 ADVANCED DIAGNOSTIC IMAGING PC NASHVILLE TN NURSE PRACTITIONER 534 27 $193,028 $7,149 premium 71.1% (615) 612-2146
3 NORTH FLORIDA SURGEONS PA JACKSONVILLE FL PHYSICIAN ASSISTANT 331 24 $112,710 $4,696 premium 15.2% (904) 396-1725
4 UNIVERSITY MEDICAL SERVICE ASSOCIATION INC TAMPA FL NURSE PRACTITIONER 814 23 $55,000 $2,391 premium 14.6%
5 ST PAUL PLACE SPECIALISTS, INC. BALTIMORE MD PHYSICIAN ASSISTANT 337 20 $102,032 $5,102 premium 100.0% (410) 663-8100
6 MERCY CLINIC OKLAHOMA COMMUNITIES OKLAHOMA CITY OK PHYSICIAN ASSISTANT 642 20 $54,780 $2,739 premium 100.0% (405) 254-9690
7 PLASTIC SURGEONS OF NORTHERN ARIZONA P L L C FLAGSTAFF AZ PLASTIC AND RECONSTRUCTIVE SURGERY 6 18 $88,896 $4,939 premium 28.6% (928) 774-2300
8 EPIC CARE PLEASANT HILL CA HEMATOLOGY/ONCOLOGY 54 17 $47,957 $2,821 premium 17.5% (925) 687-2570
9 JASON K POTTER MD DDS PA DALLAS TX PHYSICIAN ASSISTANT 2 17 $310,000 $18,235 premium 51.5% (214) 540-1420
10 THE REGENTS OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES CA PLASTIC AND RECONSTRUCTIVE SURGERY 19 15 $114,237 $7,616 premium 15.5%
11 SMH PHYSICIAN SERVICES INC SARASOTA FL PHYSICIAN ASSISTANT 766 14 $26,922 $1,923 premium 8.9%
12 THE GEORGIA INSTITUTE FOR PLASTIC SURGERY INC SAVANNAH GA PLASTIC AND RECONSTRUCTIVE SURGERY 8 14 $165,375 $11,812 premium 40.0% (912) 355-8000
13 PRISMA HEALTH MEDICAL GROUP-MIDLANDS COLUMBIA SC PHYSICIAN ASSISTANT 1017 13 $44,175 $3,398 premium 100.0% (803) 749-5101
14 BARBARA ANN KARMANOS CANCER INSTITUTE DETROIT MI DIAGNOSTIC RADIOLOGY 57 13 $36,000 $2,769 premium 100.0% (800) 527-6266
15 GARDNER PLASTIC SURGERY INC NAPLES FL PLASTIC AND RECONSTRUCTIVE SURGERY 4 13 $39,349 $3,027 premium 8.2% (239) 566-2611
16 LESTER E COX MEDICAL CENTERS SPRINGFIELD MO PHYSICIAN ASSISTANT 251 12 $43,662 $3,639 premium 100.0% (417) 875-3000
17 AESTHETIC PLASTIC SURGERY PC GREAT NECK NY PHYSICIAN ASSISTANT 10 12 $300,000 $25,000 premium 26.1% (516) 498-8400
18 REGENTS OF THE UNIVERSITY OF CALIFORNIA SAN DIEGO CA DIAGNOSTIC RADIOLOGY 2057 12 $64,622 $5,385 premium 12.4% (800) 926-8273
19 CEDARS-SINAI MEDICAL CARE FOUNDATION LOS ANGELES CA PHYSICIAN ASSISTANT 1699 12 $58,405 $4,867 premium 12.4% (310) 423-0674
20 THE PLASTIC SURGERY GROUP OF MEMPHIS P.C. MEMPHIS TN PLASTIC AND RECONSTRUCTIVE SURGERY 7 11 $34,500 $3,136 premium 28.9% (901) 761-9030
21 NATIONAL CENTER FOR PLASTIC SURGERY LLC MCLEAN VA PHYSICIAN ASSISTANT 13 11 $110,313 $10,028 premium 47.8% (703) 287-8277

*Share of the state's disclosed Medicare-FFS services for the primary code, counted once per clinician. "St" is the state the volume was billed from: a group appears in each state where its clinicians bill Medicare, with that state's volume and share ("City" is the group's registered location). Group figures sum clinicians affiliated with exactly one group; clinicians in several groups are listed in each group's drill-down but not volume-attributed to any single group, so shares reflect attributable volume. See Methods.

Comparing against an all-payer estimate?

These are exact counts from Medicare fee-for-service claims — roughly a third to half of most procedure markets, depending on payer mix. Modeled all-payer databases project the remainder statistically; we publish the audited floor and label it as such. Same market, different denominator. How the numbers reconcile →