Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method
Medicare pricing data for 6,630 providers across 52 states
Prices vary significantly by location — from $146 in Wyoming to $354 in Maryland. Where you get this procedure matters more than almost any other factor. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method (HCPCS code G0416) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $244.69, but hospitals typically charge $1,083 — a 4.4x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $244.69, your out-of-pocket cost would be approximately $48.94. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 4.4x more than what Medicare allows for this procedure. Medicare actually pays $191.84 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Maryland | $354 | $1,105 | 106 | 3,846 | +44.9% |
| District of Columbia | $302 | $979 | 15 | 775 | +23.6% |
| Arkansas | $297 | $911 | 64 | 4,205 | +21.5% |
| Puerto Rico | $297 | $560 | 10 | 110 | +21.2% |
| New Jersey | $293 | $1,482 | 168 | 6,589 | +19.7% |
| Utah | $292 | $834 | 59 | 2,125 | +19.2% |
| Hawaii | $288 | $766 | 24 | 356 | +17.6% |
| Nebraska | $272 | $996 | 38 | 734 | +11.0% |
| Tennessee | $271 | $978 | 194 | 7,591 | +10.7% |
| New York | $269 | $1,087 | 320 | 8,447 | +10.0% |
| Oklahoma | $268 | $1,522 | 71 | 4,875 | +9.5% |
| Illinois | $261 | $1,401 | 280 | 6,789 | +6.9% |
| California | $261 | $1,072 | 581 | 13,348 | +6.8% |
| Texas | $260 | $1,539 | 480 | 9,677 | +6.4% |
| Connecticut | $260 | $1,267 | 128 | 2,199 | +6.1% |
| Virginia | $257 | $1,174 | 149 | 3,976 | +4.9% |
| Florida | $254 | $928 | 423 | 8,989 | +3.8% |
| Alaska | $250 | $1,117 | 11 | 45 | +2.1% |
| Minnesota | $244 | $1,081 | 175 | 2,358 | -0.3% |
| Arizona | $243 | $664 | 148 | 3,540 | -0.9% |
| Pennsylvania | $240 | $1,232 | 298 | 5,473 | -1.8% |
| Oregon | $235 | $872 | 64 | 618 | -4.1% |
| Michigan | $234 | $1,150 | 191 | 3,208 | -4.5% |
| Idaho | $228 | $611 | 22 | 301 | -6.7% |
| New Mexico | $226 | $810 | 30 | 427 | -7.7% |
| Nevada | $225 | $784 | 57 | 772 | -8.1% |
| Alabama | $221 | $1,738 | 89 | 1,364 | -9.8% |
| Washington | $218 | $643 | 189 | 3,145 | -10.8% |
| Mississippi | $212 | $750 | 55 | 792 | -13.3% |
| Missouri | $211 | $824 | 160 | 3,054 | -13.6% |
| Georgia | $209 | $1,497 | 166 | 3,785 | -14.4% |
| Indiana | $208 | $993 | 135 | 1,989 | -14.9% |
| Massachusetts | $206 | $896 | 216 | 4,785 | -16.0% |
| Iowa | $205 | $784 | 84 | 1,523 | -16.1% |
| South Carolina | $201 | $852 | 122 | 3,099 | -17.9% |
| Ohio | $200 | $1,076 | 274 | 4,492 | -18.4% |
| Kentucky | $199 | $749 | 77 | 1,466 | -18.5% |
| Colorado | $198 | $778 | 107 | 2,511 | -19.0% |
| Kansas | $194 | $886 | 90 | 2,077 | -20.7% |
| North Carolina | $190 | $835 | 194 | 4,423 | -22.3% |
| Wisconsin | $181 | $1,032 | 175 | 2,540 | -25.9% |
| New Hampshire | $178 | $854 | 34 | 684 | -27.2% |
| Rhode Island | $176 | $3,023 | 14 | 223 | -27.9% |
| South Dakota | $174 | $726 | 43 | 463 | -28.8% |
| Louisiana | $173 | $640 | 132 | 2,208 | -29.3% |
| North Dakota | $173 | $865 | 23 | 460 | -29.5% |
| Maine | $170 | $557 | 43 | 608 | -30.3% |
| Vermont | $170 | $1,356 | 11 | 244 | -30.4% |
| Montana | $170 | $443 | 22 | 707 | -30.7% |
| West Virginia | $165 | $575 | 30 | 229 | -32.8% |
| Delaware | $149 | $519 | 25 | 537 | -39.1% |
| Wyoming | $146 | $374 | 8 | 63 | -40.1% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
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