Medicare procedure market data by CPT code & state

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Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS

86320 Immunologic analysis technique on serum CPT · General Laboratory test

Classification Test › General Laboratory › Immunoassay (CMS RBCS)

First observed 2013 — start of our 12-year window; the code predates it

National scale 42,898 services ▲ 8.8% YoY · 28,876 beneficiaries (CY2024, Medicare FFS)

Medicare paid $861K · $20.08 avg / service, national

CMS descriptor · RBCS classification · Medicare Part B physician/supplier claims, 12-year window

Billing groups

Named-group FFS services

16,524

FFS of Medicare

49%

Services YoY

+8.8%

FFS enrollment -2.2%

Estimated all-Medicare volume FFS + estimated MA estimate

~34,491 services

16,524 observed fee-for-service (48%) · ~17,967 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 — 86320 (CY2024)

AZ 16,391 MA 8,424 TN 5,139 NY 3,423 OH 2,996

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

Named-group submitted charges

$1.0M

Named-group allowed amount

$293K

Named-group Medicare payments

$222K

Avg charge / svc

$61

Avg allowed / svc

$18

Avg payment / svc

$13

Average charge per group

$40–46

$46–52

$52–58

$58–64

$64–70

$70–76

$76–82

$82+

$40 11 groups · avg submitted charge / service $103

Market analyticsPlatform

a taste of the twelve-year trend layer

Market position — where this market sits on volume and growth among all state markets, and its rank.
Worth a look — every state market for this search, ranked by a published score: size, growth, fragmentation, below-expected volume.
Lookalike opportunities — groups billing below what peers of the same specialty, size, and state predict, with the expected figure shown.
National benchmarks — where each group's volume sits nationally and within its specialty.
Market structure — how concentrated this market is, and who owns the volume.
Medicare-wide scaling — the payer split, and this market total scaled to all of Medicare, labeled as an estimate.

Or just look at it: nuclear heart imaging (78452) in Arizona is open as a live example — the full paid view, real data.

View the live example →

Nevvi's market analytics platform — code baskets, market structure and share, the twelve-year trend layer — is built and not launched yet. We're gathering interest in it.

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Data year: CY2024 CY2023 CY2022 CY2021 CY2020

Physician groups ranked by 86320 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	86320 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	DIAGNOSTIC PATHOLOGY SERV PC	CHATTANOOGA	TN	PATHOLOGY	11	5,064	$202,560	$40	premium	98.5%	(423) 624-6623
2	EAST POST ROAD MEDICAL SERVICES PC	WHITE PLAINS	NY	PHYSICIAN ASSISTANT	406	3,360	$243,566	$72	premium	98.2%	(914) 681-0600
3	MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION INC	BOSTON	MA	DIAGNOSTIC RADIOLOGY	3532	2,835	$292,005	$103	premium	33.7%	(617) 724-0287
4	UNIVERSITY HOSPITALS MEDICAL GROUP INC	CLEVELAND	MI	NURSE PRACTITIONER	2232	1,674	$83,700	$50	premium	100.0%	—
5	UNIVERSITY HOSPITALS MEDICAL GROUP INC	CLEVELAND	OH	NURSE PRACTITIONER	2232	839	$41,950	$50	premium	28.0%	—
6	VIVID PATHOLOGY PA	PENSACOLA	FL	PATHOLOGY	12	795	$35,775	$45	premium	73.7%	(448) 227-5201
7	CLEVELAND CLINIC	CLEVELAND	OH	PHYSICIAN ASSISTANT	6828	738	$36,900	$50	premium	24.6%	—
8	EAST POST ROAD MEDICAL SERVICES PC	WHITE PLAINS	CT	PHYSICIAN ASSISTANT	406	601	$43,566	$72	premium	68.7%	(914) 681-0600
9	FAIRFIELD COUNTY PATHOLOGY CONSULTANTS, LLC	BRIDGEPORT	CT	PATHOLOGY	3	274	$16,380	$60	premium	31.3%	(203) 576-5033
10	BOULDER VALLEY PATHOLOGY P C	BOULDER	CO	PATHOLOGY	4	222	$10,434	$47	premium	83.8%	(720) 854-7000
11	ASSOCIATED PATHOLOGISTS, LLC	NASHVILLE	TN	PATHOLOGY	135	75	$3,095	$41	premium	1.5%	(615) 221-4400
12	PATHFINDER DIAGNOSTICS	WARRENTON	VA	PATHOLOGY	3	18	$1,098	$61	premium	100.0%	(540) 316-5000
13	MERCY CLINIC SPRINGFIELD COMMUNITIES	SPRINGFIELD	MO	PHYSICIAN ASSISTANT	1128	17	$1,156	$68	premium	100.0%	—
14	MERCY CLINIC SPRINGFIELD COMMUNITIES	SPRINGFIELD	MN	PHYSICIAN ASSISTANT	1128	12	$816	$68	premium	100.0%	—

*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 →