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

86780 Analysis for antibody, treponema pallidum 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 39,856 services ▼ 12.8% YoY · 35,231 beneficiaries (CY2024, Medicare FFS)

Medicare paid $517K · $12.96 avg / service, national

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

Billing groups

Named-group FFS services

582

FFS of Medicare

49%

Services YoY

-12.8%

FFS enrollment -2.2%

Estimated all-Medicare volume FFS + estimated MA estimate

~1,196 services

582 observed fee-for-service (49%) · ~614 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 — 86780 (CY2024)

NJ 6,537 NC 5,416 TX 4,771 NY 3,914 FL 2,895

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

Named-group submitted charges

$35K

Named-group allowed amount

$8K

Named-group Medicare payments

$8K

Avg charge / svc

$60

Avg allowed / svc

$13

Avg payment / svc

$13

Average charge per group

$17–33

$33–49

$49–65

$65–81

$81–97

$97–113

$113–129

$129+

$17 16 groups · avg submitted charge / service $220

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.

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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 86780 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	86780 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	CRYSTAL RUN HEALTHCARE PHYSICIANS LLP	MIDDLETOWN	NY	NURSE PRACTITIONER	372	98	$5,390	$55	premium	2.5%	(845) 703-6999
2	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	ELMHURST	NY	NURSE PRACTITIONER	473	70	$2,730	$39	premium	1.8%	(718) 334-4000
3	DUPAGE MEDICAL GROUP LTD	GLEN ELLYN	IL	PHYSICIAN ASSISTANT	1323	58	$3,944	$68	premium	4.2%	(630) 469-9200
4	ALLINA HEALTH SYSTEM	MINNEAPOLIS	MN	PHYSICIAN ASSISTANT	3855	48	$2,976	$62	premium	6.0%	(612) 863-4000
5	CLEVELAND CLINIC	CLEVELAND	OH	PHYSICIAN ASSISTANT	6828	46	$1,770	$38	premium	3.7%	—
6	CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.	OKLAHOMA CITY	OK	MENTAL HEALTH COUNSELOR	58	37	$4,440	$120	premium	5.2%	(405) 948-4900
7	ATRIUS HEALTH INC	BOSTON	MA	NURSE PRACTITIONER	1196	31	$2,232	$72	premium	1.5%	(617) 421-1000
8	PHYSICIANS FOR WOMEN'S HEALTH, LLC	DANBURY	CT	OBSTETRICS/GYNECOLOGY	320	30	$1,260	$42	premium	33.3%	(203) 730-8789
9	REGIONAL WOMENS HEALTH GROUP LLC	VOORHEES	PA	OBSTETRICS/GYNECOLOGY	352	25	$1,100	$44	premium	1.8%	(856) 424-3323
10	GWINNETT CLINIC, LTD	LAWRENCEVILLE	GA	INTERNAL MEDICINE	40	22	$1,210	$55	premium	2.6%	(770) 972-9000
11	ATRIUS HEALTH INC	BOSTON	NY	NURSE PRACTITIONER	1196	21	$1,512	$72	premium	0.5%	(617) 421-1000
12	THE AUSTIN DIAGNOSTIC CLINIC PLLC	AUSTIN	TX	NEPHROLOGY	86	21	$795	$38	premium	0.4%	(512) 447-2211
13	BORO PARK OBSTETRICS AND GYNECOLOGY P.C.	BROOKLYN	NY	OBSTETRICS/GYNECOLOGY	17	17	$425	$25	premium	0.4%	71897227001121
14	NOVANT HEALTH MEDICAL GROUP COASTAL REGION LLC	WILMINGTON	NC	PHYSICIAN ASSISTANT	560	17	$969	$57	premium	0.3%	(910) 662-6000
15	COMMUNITY HEALTH CENTERS OF BURLINGTON INC	BURLINGTON	VT	NURSE PRACTITIONER	89	15	$450	$30	premium	100.0%	(802) 864-6309
16	PROFESSIONAL GYNECOLOGICAL SERVICES PC	BROOKLYN	NY	OBSTETRICS/GYNECOLOGY	5	15	$3,300	$220	premium	0.4%	(718) 875-4848
17	LOUISIANA DEPARTMENT OF HEALTH - OFFICE OF PUBLIC HEALTH	CROWLEY	LA	NURSE PRACTITIONER	33	11	$191	$17	premium	11.2%	(337) 788-7507

*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 →