Validating national trends in breast reconstruction hospital price variation: A detailed analysis of a state market.

The Hospital Price Transparency Rule requires hospitals to report rates for a selection of procedures. While previous studies have evaluated commercial payer-specific rates nationally, we analyzed variation in breast reconstruction charges in Texas. Our goal was to determine whether national patterns in procedure rate variation persist in smaller markets. For 17 Current Procedural Terminology (CPT) codes, we calculated within-hospital price ratios (WHRs) by dividing the highest commercial rate by the lowest rate for a given code at each hospital and across-hospital ratios (AHRs) by dividing the 90th percentile by the 10th percentile within each code. Averaged across all codes, Texas WHRs were 2.4 times their national counterparts, and Texas AHRs were 0.42 times their national counterparts. Texas and national WHRs showed no correlation across procedure codes (Spearman r = 0.154, p = 0.555), while Texas and national AHRs showed statistically significant correlation (Spearman r = 0.847, p < 0.001). Our results demonstrate that only some aspects of rate variation are consistent with national patterns, supporting the need for state-level research and advocacy for breast reconstruction patients and insurers.