Regional Price Variation for Neurosurgical Oncology Services in Academic and Community Hospitals

Introduction: The United States has long struggled with price transparency and high cost variability across hospitals, payers, and regions. Using hospital published data made publicly available through the Price Transparency Act, we collected and compared prices for common neurosurgical oncology services at both academic and community hospitals to assess overall costs and price variation.

Methods: In October 2023, we extracted prices from 114 academic hospitals with neurosurgical training programs and 94 regionally similar community hospitals advertising neurosurgical oncology services using their online machine-readable files with standard, payer-negotiated charges. We compared 10 common neurosurgical oncology services across three national commercial payers (Aetna, BCBS/Anthem, United) and Medicare.

Results: Average commercial and Medicare prices for academic and community hospitals were as follows: spinal instrumentation [Academic ($5842, commercial; $2762, Medicare) versus community ($9572, commercial; $8685, Medicare)], craniotomy for tumor ($7258; $4216 vs. $5208; $4458), stereotactic navigation (cranial) ($1706; $537 vs. $1903; $687), stereotactic navigation (spine) ($2407; $416 vs. $4855; $5309), stereotactic radiosurgery (cranial) ($13673; $1871 vs. $9040; $6418), laminectomy for tumor in the cervical ($5753; $3298 vs. $4943; $4003), thoracic ($6441; $3510 vs. $5208; $4458), lumbar ($6542; $3092 vs. $5528; $2884), sacral ($6133; $3492 vs. $5686; $3613) regions, and spinal stereotactic radiosurgery ($9909; $2445 vs. $5788; $7065). Regional price trends were evident; community hospital commercial prices were consistently higher in the Midwest (range: 39% to 483%) and generally higher in the West (-9% to 230%), but lower in the South (-105% to 22%), and markedly lower in the Northeast (-897% to 49%).

Conclusion : Commercial payer-negotiated rates are generally higher than Medicare for both academic and community hospitals. There is marked price variation for common neurosurgical oncological services when considering the hospital itself, academic status, payer, and regionality. Consistent trends exist at a regional level, with academic hospitals charging significantly higher rates than their non-academic counterparts in the northeast and south.