Considerable Variation Seen in Commercial Pricing for Surgery Services

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By Elana Gotkine HealthDay Reporter

Medically reviewed by Drugs.com

via HealthDay

THURSDAY, July 3, 2025 -- Commercial pricing varies considerably for general surgery services, with facility prices exhibiting greater variability, according to a research letter published online June 25 in JAMA Network Open.

Alexander P. Philips, and Christopher M. Whaley, Ph.D., both from Brown University School of Public Health in Providence, Rhode Island, examined price data from ClarifyHealth for common surgical services across four large national insurers, which constitute 78 percent of market share. Commercial prices were analyzed for practitioners and facilities with billed claims during 2023 for 10 common general surgery procedures.

The sample included approximately 2.45 million price points and 97,740 unique physicians for professional data, as well as 132,000 price points and 5,298 unique facilities for facility data. The researchers found that the magnitude of facility prices was about nine and four times higher than professional prices for surgical and endoscopic procedures, respectively. Price variation was moderate and high for professional services and facility services, respectively, especially for endoscopic procedures. For example, the median facility cost for diagnostic colonoscopy ranged from $925 to $3,571 depending on the payer. For diagnostic colonoscopy, professional and facility prices have an upper limit of about two and about three times the lower bound, respectively.

"If price variation reflects clinical or perceived quality variation, purchasers and policymakers must find the balance between receiving higher-quality care and spending financial resources elsewhere," the authors write. "If price variation is instead driven by consolidation or anticompetitive contracting, then regulators should design policies that ensure competitive health care markets."

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Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

Source: HealthDay

Posted : 2025-07-04 12:00

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