Cost analysis for CPT G0416 — Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method
Average Medicare Payment
$161.62
2023 data
Total Payments (2023)
$26.1M
Services (2023)
132.8K
Price Change (2014–2023)
-48.4%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $313.19 | $26.6M | 69.4K | — |
| 2015 | $246.42 | $42.1M | 119.6K | -21.3% |
| 2016 | $200.88 | $35.8M | 126.8K | -18.5% |
| 2017 | $201.30 | $34.6M | 130.2K | +0.2% |
| 2018 | $190.44 | $32.0M | 134.0K | -5.4% |
| 2019 | $177.87 | $29.9M | 137.9K | -6.6% |
| 2020 | $172.53 | $23.2M | 116.2K | -3.0% |
| 2021 | $166.33 | $25.5M | 127.4K | -3.6% |
| 2022 | $163.12 | $25.5M | 128.8K | -1.9% |
| 2023 | $161.62 | $26.1M | 132.8K | -0.9% |
The most expensive state pays 2.5x more than the cheapest for this procedure. MD averages $291.27 vs DE at $116.28.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| MD | $291.27 | $1.0M | 3.6K | 26 |
| DC | $243.08 | $181.6K | 747 | 8 |
| AR | $237.93 | $954.1K | 4.0K | 19 |
| NJ | $233.32 | $1.4M | 6.2K | 70 |
| HI | $229.20 | $66.9K | 292 | 8 |
| UT | $228.62 | $453.1K | 2.0K | 20 |
| NE | $218.24 | $149.5K | 685 | 20 |
| CT | $216.92 | $387.4K | 1.8K | 34 |
| TN | $216.53 | $1.5M | 7.1K | 67 |
| NY | $215.17 | $1.7M | 7.8K | 135 |
| IL | $211.40 | $1.3M | 6.1K | 119 |
| TX | $210.84 | $1.8M | 8.6K | 139 |
| OK | $209.87 | $989.3K | 4.7K | 26 |
| FL | $207.94 | $1.6M | 7.8K | 134 |
| VA | $206.39 | $747.1K | 3.6K | 56 |
| CA | $206.39 | $2.5M | 12.2K | 243 |
| PA | $200.39 | $911.8K | 4.5K | 101 |
| MN | $197.47 | $365.7K | 1.9K | 51 |
| AZ | $195.64 | $627.4K | 3.2K | 56 |
| ID | $195.51 | $44.4K | 227 | 5 |
| OR | $193.12 | $79.2K | 410 | 18 |
| NV | $188.40 | $112.5K | 597 | 10 |
| MI | $187.78 | $509.5K | 2.7K | 70 |
| NM | $186.60 | $64.2K | 344 | 10 |
| AL | $178.48 | $202.4K | 1.1K | 30 |
| WA | $173.69 | $476.6K | 2.7K | 67 |
| GA | $168.92 | $560.8K | 3.3K | 66 |
| MS | $168.61 | $117.4K | 696 | 22 |
| MO | $167.17 | $442.3K | 2.6K | 51 |
| IN | $165.01 | $283.2K | 1.7K | 53 |
| MA | $162.99 | $712.1K | 4.4K | 101 |
| IA | $160.79 | $214.5K | 1.3K | 39 |
| SC | $160.27 | $449.6K | 2.8K | 52 |
| OH | $159.72 | $600.5K | 3.8K | 115 |
| KY | $159.48 | $206.7K | 1.3K | 33 |
| CO | $155.02 | $348.2K | 2.2K | 44 |
| NC | $148.27 | $581.9K | 3.9K | 70 |
| KS | $148.21 | $278.8K | 1.9K | 39 |
| RI | $140.37 | $26.0K | 185 | 7 |
| WI | $140.03 | $283.8K | 2.0K | 62 |
| NH | $134.52 | $83.9K | 624 | 19 |
| LA | $134.36 | $253.3K | 1.9K | 50 |
| ME | $132.95 | $68.6K | 516 | 18 |
| MT | $132.59 | $90.0K | 679 | 15 |
| VT | $130.11 | $27.5K | 211 | 6 |
| ND | $130.08 | $56.3K | 433 | 15 |
| SD | $128.92 | $40.9K | 317 | 14 |
| WV | $125.40 | $16.8K | 134 | 7 |
| DE | $116.28 | $59.7K | 513 | 18 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Dianon Systems Inc | Clinical Laboratory | OK | $817.5K | 3.6K | $226.76 |
| Michael Nagar | Pathology | NY | $427.7K | 1.3K | $336.24 |
| Inform Diagnostics, Inc | Clinical Laboratory | TX | $352.2K | 1.5K | $241.04 |
| Nicholas Maruniak | Pathology | FL | $351.3K | 1.3K | $276.20 |
| Matthew Lindberg | Pathology | AR | $307.4K | 1.3K | $233.93 |
| Adam Cole | Pathology | AR | $295.9K | 1.2K | $239.25 |
| Ali Shahabi | Pathology | MD | $289.6K | 885 | $327.24 |
| Richard Roberts | Pathology | TN | $270.8K | 1.1K | $244.83 |
| Kirk Lin | Pathology | AZ | $260.5K | 1.1K | $244.83 |
| Hillary Epstein | Pathology | MD | $259.6K | 781 | $332.40 |
| Zhiming Yang | Pathology | PA | $232.0K | 762 | $304.41 |
| Path Md, Inc. | Clinical Laboratory | CA | $216.7K | 753 | $287.75 |
| Dianon Systems, Inc | Clinical Laboratory | CT | $215.4K | 919 | $234.37 |
| Changhyun Choi | Pathology | TN | $215.2K | 897 | $239.91 |
| Leonid Li | Pathology | NJ | $195.0K | 1.2K | $161.31 |
| Luisa Lerma | Pathology | NJ | $189.0K | 591 | $319.87 |
| Kenneth Beck | Pathology | IL | $181.0K | 607 | $298.22 |
| James Bentley | Pathology | NJ | $180.1K | 561 | $321.03 |
| Tehmina Ali | Pathology | MD | $178.2K | 533 | $334.25 |
| Jefferson Lin | Pathology | VA | $173.6K | 653 | $265.83 |
The data suggests significant pricing inconsistencies for CPT G0416. With a 2.5x price gap between the most and least expensive states, geography plays an outsized role in what Medicare pays for this procedure.
While costs have decreased 48.4% since 2014, the wide state-by-state variation suggests the pricing formula may not adequately account for regional differences.
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.