Medicare procedure market data by CPT code & state

+ Build a code basket

Market snapshot

Nationwide CY2024

Medicare Part B FFS · CY2024 · as published by CMS

94681 Test to measure exhaled air and carbon dioxide for evaluation of lung function CPT · Pulmonary test

Classification Test › Pulmonary (CMS RBCS)

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

National scale 2,552 services ▲ 3.7% YoY · 2,460 beneficiaries (CY2024, Medicare FFS)

Medicare paid $46K · $18.03 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

1,809

Attributable volume · fee-for-service

FFS of Medicare

49%

Payer-mix frame

Services · year over year

Services YoY

+3.7%

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

~4,245 services

1,809 observed fee-for-service (43%) · ~2,436 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 — 94681 (CY2024)

MN 1,318 CA 397 AZ 273 FL 241 NY 157

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

$240K

Named-group allowed amount

$26K

Named-group Medicare payments

$19K

Avg charge / svc

$133

Avg allowed / svc

$14

Avg payment / svc

$11

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

$45–82

$82–119

$119–157

$157–194

$194–231

$231–268

$268–305

$305+

$45 9 groups · avg submitted charge / service $390

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 94681 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	94681 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	MAYO CLINIC	ROCHESTER	MN	NURSE PRACTITIONER	4896	1,260	$124,740	$99	premium	95.6%	(507) 284-2511
2	MAYO CLINIC ARIZONA	PHOENIX	AZ	PHYSICIAN ASSISTANT	1635	246	$54,714	$222	premium	90.1%	(800) 603-0558
3	TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	NEW YORK	NY	NURSE PRACTITIONER	2273	87	$33,930	$390	premium	55.4%	(212) 305-8559
4	CARDIOLOGY CLINICAL GROUP	ROCHESTER	NY	CARDIOVASCULAR DISEASE (CARDIOLOGY)	148	48	$2,160	$45	premium	30.6%	(585) 242-9450
5	PULMONARY GROUP OF CENTRAL FLORIDA LLC	LEESBURG	FL	NURSE PRACTITIONER	2	40	$3,600	$90	premium	16.6%	(352) 315-1627
6	VENTURA ADVANCED SURGICAL ASSOCIATES	VENTURA	CA	GENERAL SURGERY	2	36	$6,300	$175	premium	9.1%	(805) 676-9100
7	MAYO CLINIC	ROCHESTER	AZ	NURSE PRACTITIONER	4896	27	$2,673	$99	premium	9.9%	(507) 284-2511
8	MAYO CLINIC JACKSONVILLE	JACKSONVILLE	FL	NURSE PRACTITIONER	1587	26	$7,046	$271	premium	10.8%	(904) 953-2000
9	INDEPENDENT PHYSICIANS OF WISCONSIN LLC	MILWAUKEE	WI	FAMILY PRACTICE	41	24	$4,008	$167	premium	38.7%	(414) 875-0505
10	ALTOONA LUNG SPECIALISTS	ALTOONA	PA	CRITICAL CARE (INTENSIVISTS)	5	15	$1,125	$75	premium	26.3%	(814) 946-2845

*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 →