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Market snapshot

78431 in PA CY2024

Medicare Part B FFS · CY2024 · as published by CMS

78431 — Nuclear medicine studies of blood flow in heart muscle at rest and with stress with concurrent ct scan

Billing groups
13
Named-group FFS services
9,463
FFS of Medicare
46%
Services YoY
+47.0%
FFS enrollment -2.5%
Estimated all-Medicare volume FFS + estimated MA estimate
~20,094 services

9,463 observed fee-for-service (47%) · ~10,631 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

Named-group submitted charges
$50.5M
Named-group allowed amount
$19.4M
Named-group Medicare payments
$15.6M
Avg charge / svc
$5,333
Avg allowed / svc
$2,054
Avg payment / svc
$1,647
Average charge per group
$172 13 groups · avg submitted charge / service $7,489
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Specialty market — Cardiovascular Disease (Cardiology): 5,300 services — specialty benchmark suppressed (fewer than 11 groups) — showing state benchmark. See Cardiovascular Disease (Cardiology) across all states →

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Data year: CY2024 CY2023 CY2022 🔒 CY2021 🔒 CY2020 🔒
Physician groups ranked by 78431 services, CY2024
#Physician group City Specialty Providers 78431 svcs Submitted charges Avg charge Medicare $ locked column Share of specialty*Share of state* Phone
1 CARDIOLOGY CONSULTANTS OF PHILADELPHIA PC PHILADELPHIA CARDIOVASCULAR DISEASE (CARDIOLOGY) 143 4,888 $36,608,506 $7,489 premium 41.7% (215) 463-5333
2 PINNACLE HEALTH CARDIOVASCULAR INSTITUTE INC MECHANICSBURG CARDIOVASCULAR DISEASE (CARDIOLOGY) 113 158 $27,176 $172 premium 1.3% (717) 731-0101
3 CARDIOVASCULAR ASSOCIATES OF THE DELAWARE VALLEY,P A HADDON HEIGHTS CARDIOVASCULAR DISEASE (CARDIOLOGY) 94 133 $651,700 $4,900 premium 1.1% (856) 546-3003
4 CAROLINA CARDIOLOGY ASSOCIATES LLC ROCK HILL CARDIOVASCULAR DISEASE (CARDIOLOGY) 16 121 $564,465 $4,665 premium 1.0% (803) 324-5130

*"Share of specialty" is the group's share of disclosed Medicare-FFS services for the primary code among groups with the SAME modal specialty in the state; "share of state" is the same figure against the whole state. Specialty is each group's modal member specialty from CMS's clinician register — a multi-specialty group carries one label. Where fewer than 11 groups share the specialty in the state, the specialty share renders "—" — the specialty benchmark is suppressed (fewer than 11 groups) and the state share alongside is the benchmark. Group figures sum clinicians affiliated with exactly one group. 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 →