Significant Variability in Commercial Prices for Surgical Procedures

Recent research highlights considerable differences in the pricing of surgical services across healthcare facilities and providers. A study published online June 25 in JAMA Network Open detailed how facility charges tend to be much higher than professional service fees, with facility prices being roughly nine times greater for surgeries and four times for endoscopic procedures. The analysis, conducted by Alexander P. Philips and Christopher M. Whaley from Brown University, examined extensive claims data from ClarifyHealth, covering over 2.4 million price points related to ten common surgeries across four major insurers representing 78% of the market share.

The study revealed a wide range of costs depending on geographic location, insurer, and provider. For example, the median price for a diagnostic colonoscopy varied significantly, from about $925 to over $3,500 for different payers. Professional fees for the same procedure exhibited less variation but still showed a broad upper-to-lower price ratio, around twice to three times for facility costs.

The authors emphasized that if price differences reflect disparities in clinical quality or patient perception, stakeholders need to balance cost and quality considerations. Conversely, if these variations are driven by healthcare market consolidation or anti-competitive practices, policymakers should implement regulations to promote fair competition. This study underscores the importance of transparency in healthcare pricing and the need for strategies to ensure affordable, high-quality surgical care.

For further details, see the original research in JAMA Network Open (2025). Source: https://medicalxpress.com/news/2025-07-considerable-variation-commercial-pricing-surgery.html