Temporary Procedures · G0416
Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method
What Medicare pays for G0416, what providers bill, and how the price varies across 52 states, drawn from CMS 2023 claims data.
- $191.84
- Medicare pays
- $1,082.51
- Providers bill
- 5.6×
- Markup
- #986 of 9,297
- Volume rank
The verdict
Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method pairs top-quartile national service volume with a below-median markup.
- Top 11%
- national service volume
- 47th pct.
- billed-to-Medicare markup
- 5.6×
- billed vs. Medicare
- $191.84
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Temporary Procedures, the applied ratio is 2.24x Medicare (RAND 2024 national average (2.24x); no matching CPT-section bucket for this category + CMS Medicare baseline). Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
6 more affordable than 47% of 8,901 procedures
Each bar is a 1-wide band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
What the billed charge breaks down into
$1,082.51
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Maryland | $279.77 | $1,105.12 |
| District of Columbia | $239.65 | $979.42 |
| Arkansas | $232.79 | $911.33 |
| New Jersey | $230.48 | $1,481.60 |
| Hawaii | $228.66 | $765.78 |
| Puerto Rico | $228.04 | $559.60 |
| Utah | $226.65 | $834.39 |
| Nebraska | $212.65 | $996.26 |
| Tennessee | $212.17 | $977.78 |
| New York | $211.97 | $1,086.83 |
| Oklahoma | $207.72 | $1,521.93 |
| Illinois | $205.88 | $1,400.59 |
| Connecticut | $205.21 | $1,266.62 |
| California | $205.00 | $1,072.05 |
| Texas | $203.99 | $1,538.97 |
| Virginia | $202.19 | $1,173.93 |
| Florida | $200.63 | $927.64 |
| Alaska | $195.16 | $1,116.74 |
| Arizona | $190.87 | $664.28 |
| Pennsylvania | $189.41 | $1,232.19 |
| Minnesota | $188.25 | $1,081.38 |
| Oregon | $185.02 | $871.98 |
| Michigan | $179.73 | $1,150.41 |
| Idaho | $178.33 | $610.89 |
| Nevada | $177.26 | $783.68 |
| New Mexico | $175.85 | $809.95 |
| Alabama | $172.68 | $1,737.76 |
| Washington | $170.19 | $642.53 |
| Mississippi | $165.45 | $749.98 |
| Georgia | $165.43 | $1,497.23 |
| Missouri | $165.15 | $824.45 |
| Indiana | $163.92 | $993.03 |
| Massachusetts | $161.42 | $895.95 |
| South Carolina | $158.63 | $852.01 |
| Iowa | $157.72 | $783.96 |
| Ohio | $156.25 | $1,075.84 |
| Kentucky | $156.01 | $749.49 |
| Colorado | $153.87 | $777.51 |
| Kansas | $150.51 | $886.19 |
| North Carolina | $149.46 | $834.97 |
| Wisconsin | $140.42 | $1,032.43 |
| Rhode Island | $139.45 | $3,022.57 |
| Louisiana | $135.56 | $639.95 |
| New Hampshire | $134.53 | $853.91 |
| Montana | $133.26 | $443.10 |
| Maine | $132.02 | $556.59 |
| South Dakota | $131.40 | $725.72 |
| North Dakota | $130.35 | $865.45 |
| Vermont | $130.27 | $1,356.39 |
| West Virginia | $126.68 | $574.86 |
| Delaware | $117.15 | $518.80 |
| Wyoming | $115.28 | $373.65 |
What the Data Says About Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method
Across 52 states with reporting providers, CPT code G0416 (Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method) shows a national average Medicare payment of $191.84 against an average billed charge of $1,082.51. That gap, a 5.6x markup, or 464% above the Medicare allowed amount, is narrower than most procedures in our dataset, suggesting providers price this code closer to what payers actually reimburse.
Temporary Procedures procedures like this one saw 149.0K services billed to Medicare in 2023 by 6.6K distinct providers, serving 134.0K unique beneficiaries. State-level variation is significant: Wyoming reports the lowest average payment at $115.28, while Maryland reports the highest at $279.77. A 143% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes. Applying the RAND 2024 commercial-to-Medicare ratio for this category (2.24x Medicare; RAND 2024 national average (2.24x); no matching CPT-section bucket for this category + CMS Medicare baseline), the estimated commercial insurance price lands near $548.11, with self-pay cash discounts commonly bringing the figure closer to $481.21. Within Temporary Procedures, Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method ranks #22 of 172 tracked procedures by national average Medicare payment.
Where this sits in the registry
Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method (G0416) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Temporary Procedures codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method rank among Medicare procedures?
According to CMS Medicare Part B claims, Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method (CPT G0416) ranks #986 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #22 of 172 within Temporary Procedures by national average Medicare payment. See /methodology#corpus-placement.
How much does Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method cost?
Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method (CPT G0416) shows unusually wide state-to-state pricing: Medicare pays $191.84 on average nationally, but the $115.28-$279.77 range across states spans more than double from cheapest to priciest.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method cost with insurance?
With commercial insurance, surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method costs an estimated $548.11 on average (range: $383.68-$767.36), a moderate premium over Medicare's $191.84. Without insurance, the estimated cash price is $481.21.
Which state has the lowest cost for Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method?
Wyoming has by far the lowest average Medicare payment for Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method at $115.28, while Maryland pays more than double at $279.77 - a $164.49 gap.
How many providers perform Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method?
A moderate provider base performs Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method: 6.6K providers nationally, totaling 149.0K Medicare-billed services (134.0K beneficiaries) across 52 states in 2023.
What is the billed-to-Medicare markup for Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method?
Providers bill 5.6x what Medicare pays for Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biopsy, Any Method - a below-median markup at 464% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest national service volume
Nearest codes with ≥100 services (149.0K here).
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($191.84 here).
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.