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

86762 Analysis for antibody to rubella (german measles virus) 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 21,833 services ▲ 23.5% YoY · 19,550 beneficiaries (CY2024, Medicare FFS)

Medicare paid $307K · $14.07 avg / service, national

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

Billing groups

Named groups billing this code

Named-group FFS services

509

Attributable volume · fee-for-service

FFS of Medicare

49%

Payer-mix frame

Services · year over year

Services YoY

+23.5%

FFS enrollment -2.2%

Volume, not care. A shrinking fee-for-service denominator is not a shrinking market.

Estimated all-Medicare volume estimate

FFS + estimated MA

~1,019 services

509 observed fee-for-service (50%) · ~510 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 — 86762 (CY2024)

NJ 6,197 CA 5,930 NY 2,015 NC 1,382 TX 833

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

Billed → allowed → paid

Named-group submitted charges

$41K

Named-group allowed amount

$7K

Named-group Medicare payments

$7K

Avg charge / svc

$80

Avg allowed / svc

$14

Avg payment / svc

$14

Totals are named-group (attributable) sums. Allowed is Medicare’s fee-schedule recognized price — what CMS recognizes, before the 80% Medicare pays.

Average charge per group

$14–25

$25–36

$36–47

$47–57

$57–68

$68–79

$79–90

$90+

$14 7 groups · avg submitted charge / service $105

Market analyticsPlatform Methods →

Search a single state to see that market's full analytics — the free tier previews every panel, gated.

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 →

Data year: CY2024 CY2023 CY2022 CY2021 CY2020

Physician groups ranked by 86762 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	86762 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	FACULTY PHYSICIANS AND SURGEONS OF LLUSM	LOMA LINDA	CA	DIAGNOSTIC RADIOLOGY	1317	382	$34,380	$90	premium	6.4%	—
2	OPTUM CARE WASHINGTON PLLC	EVERETT	WA	PHYSICIAN ASSISTANT	695	33	$998	$30	premium	13.3%	(425) 339-5442
3	ATRIUS HEALTH INC	BOSTON	MA	NURSE PRACTITIONER	1196	30	$1,740	$58	premium	4.8%	(617) 421-1000
4	SUTTER BAY MEDICAL FOUNDATION	PALO ALTO	CA	INTERNAL MEDICINE	3716	21	$2,205	$105	premium	0.4%	(415) 600-1020
5	BORO PARK OBSTETRICS AND GYNECOLOGY P.C.	BROOKLYN	NY	OBSTETRICS/GYNECOLOGY	17	16	$656	$41	premium	0.8%	71897227001121
6	OPTUM MEDICAL CARE PC	MOUNT KISCO	NY	INTERNAL MEDICINE	1040	14	$201	$14	premium	0.7%	(914) 241-1050
7	REGIONAL WOMENS HEALTH GROUP LLC	VOORHEES	PA	OBSTETRICS/GYNECOLOGY	352	13	$403	$31	premium	4.7%	(856) 424-3323

*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 →