Cost analysis for CPT 55700 — Biopsy of prostate gland
Average Medicare Payment
$164.62
2023 data
Total Payments (2023)
$31.8M
Services (2023)
139.2K
Price Change (2014–2023)
+2.4%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $160.80 | $22.3M | 120.3K | — |
| 2015 | $167.53 | $26.8M | 128.3K | +4.2% |
| 2016 | $167.75 | $28.4M | 132.6K | +0.1% |
| 2017 | $178.35 | $30.6M | 139.3K | +6.3% |
| 2018 | $178.07 | $32.5M | 146.5K | -0.2% |
| 2019 | $178.02 | $34.8M | 154.4K | -0.0% |
| 2020 | $178.15 | $28.6M | 126.1K | +0.1% |
| 2021 | $176.19 | $31.2M | 137.4K | -1.1% |
| 2022 | $167.94 | $30.7M | 137.7K | -4.7% |
| 2023 | $164.62 | $31.8M | 139.2K | -2.0% |
The most expensive state pays 4.0x more than the cheapest for this procedure. MD averages $369.16 vs VT at $91.83.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| MD | $369.16 | $2.7M | 7.2K | 141 |
| KY | $313.96 | $569.8K | 1.8K | 51 |
| NE | $313.14 | $614.4K | 2.0K | 46 |
| MS | $290.84 | $672.4K | 2.3K | 51 |
| GA | $288.86 | $1.5M | 5.2K | 166 |
| NJ | $285.49 | $1.3M | 4.6K | 163 |
| RI | $273.37 | $106.1K | 388 | 11 |
| CO | $269.51 | $775.4K | 2.9K | 84 |
| VA | $261.46 | $1.2M | 4.7K | 120 |
| OR | $259.76 | $392.2K | 1.5K | 53 |
| SD | $258.79 | $258.8K | 1.0K | 18 |
| HI | $254.35 | $52.9K | 208 | 8 |
| PA | $251.94 | $1.7M | 6.9K | 206 |
| FL | $251.75 | $2.5M | 10.0K | 324 |
| TN | $249.28 | $1.2M | 4.6K | 114 |
| NV | $244.16 | $198.0K | 811 | 28 |
| KS | $240.07 | $561.8K | 2.3K | 50 |
| AR | $229.76 | $385.1K | 1.7K | 40 |
| CA | $220.85 | $2.4M | 10.8K | 345 |
| TX | $217.66 | $1.8M | 8.2K | 295 |
| AZ | $217.54 | $811.9K | 3.7K | 111 |
| AK | $215.64 | $71.4K | 331 | 12 |
| OH | $213.25 | $1.2M | 5.4K | 173 |
| MO | $204.83 | $436.5K | 2.1K | 82 |
| SC | $203.17 | $726.5K | 3.6K | 98 |
| IL | $202.66 | $1.2M | 5.7K | 178 |
| NY | $192.92 | $1.5M | 7.6K | 233 |
| WA | $178.04 | $480.9K | 2.7K | 100 |
| AL | $176.74 | $254.5K | 1.4K | 64 |
| IA | $176.64 | $252.6K | 1.4K | 53 |
| IN | $175.79 | $552.2K | 3.1K | 115 |
| WI | $175.79 | $281.8K | 1.6K | 71 |
| MA | $175.68 | $560.2K | 3.2K | 108 |
| MN | $164.36 | $280.1K | 1.7K | 63 |
| MI | $164.09 | $436.5K | 2.7K | 113 |
| UT | $162.71 | $142.2K | 874 | 38 |
| WY | $160.93 | $52.1K | 324 | 12 |
| CT | $159.20 | $134.8K | 847 | 36 |
| NM | $158.22 | $59.6K | 377 | 17 |
| DE | $153.63 | $132.9K | 865 | 21 |
| DC | $152.28 | $58.5K | 384 | 13 |
| NC | $150.94 | $483.2K | 3.2K | 131 |
| OK | $146.67 | $185.2K | 1.3K | 57 |
| ID | $146.30 | $77.7K | 531 | 23 |
| LA | $137.08 | $214.1K | 1.6K | 67 |
| NH | $132.26 | $85.7K | 648 | 21 |
| MT | $126.29 | $119.7K | 948 | 27 |
| ME | $109.99 | $33.3K | 303 | 19 |
| ND | $93.09 | $42.4K | 456 | 12 |
| WV | $91.88 | $43.7K | 476 | 23 |
| VT | $91.83 | $25.1K | 273 | 12 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Med Atlantic Inc | Ambulatory Surgical Center | VA | $485.2K | 767 | $632.66 |
| Midlantic Urology Surgery Center, Llc | Ambulatory Surgical Center | PA | $380.2K | 579 | $656.69 |
| Aesthetic Plastic Surgery Institute Of Louisville, Llc | Ambulatory Surgical Center | KY | $345.5K | 566 | $610.41 |
| The Urology Center Llc | Ambulatory Surgical Center | OH | $344.2K | 550 | $625.86 |
| Uropartners Surgery Center, Llc | Ambulatory Surgical Center | IL | $341.8K | 512 | $667.51 |
| Summit Ambulatory Surgical Center, Llc | Ambulatory Surgical Center | MD | $316.2K | 500 | $632.38 |
| Urology Surgery Center Lp | Ambulatory Surgical Center | TN | $307.3K | 514 | $597.89 |
| Chesapeake Regional Surgery Center At Virginia Beach, Llc | Ambulatory Surgical Center | VA | $279.0K | 452 | $617.26 |
| Johns Hopkins Surgery Centers Series | Ambulatory Surgical Center | MD | $277.1K | 435 | $636.97 |
| Pasteur Plaza Surgery Center Lp | Ambulatory Surgical Center | TX | $263.4K | 437 | $602.64 |
| Centerview Surgery Center, Llc | Ambulatory Surgical Center | AR | $245.1K | 404 | $606.62 |
| Anne Arundel Urological Surgery Center Llc | Ambulatory Surgical Center | MD | $224.7K | 351 | $640.28 |
| Houston Urologic Surgicenter, Llc | Ambulatory Surgical Center | TX | $224.4K | 343 | $654.15 |
| Shore Outpatient Surgicenter Llc | Ambulatory Surgical Center | NJ | $224.0K | 329 | $681.00 |
| Summit Ambulatory Surgical Center, Llc | Ambulatory Surgical Center | MD | $218.4K | 328 | $665.83 |
| Wichita Urology Surgery Center Llc | Ambulatory Surgical Center | KS | $211.5K | 351 | $602.56 |
| Urology Surgical Center Llc | Ambulatory Surgical Center | NE | $197.8K | 314 | $629.97 |
| Usc Ambulatory Surgical Center Prof Llc | Ambulatory Surgical Center | SD | $194.2K | 323 | $601.35 |
| Urlogy Ambulatory Surgery Center Llc | Ambulatory Surgical Center | TN | $180.1K | 305 | $590.48 |
| Fort Sanders West Op Surgery Center | Ambulatory Surgical Center | TN | $166.2K | 297 | $559.62 |
The data suggests significant pricing inconsistencies for CPT 55700. With a 4.0x price gap between the most and least expensive states, geography plays an outsized role in what Medicare pays for this procedure.
Costs have remained relatively stable over time, but the geographic variation suggests Medicare's geographic adjustment factors may not fully capture the true cost differences across states.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.