Price Comparison for Gastroenterology Tests and Procedures in the U.S

Price Comparison for Gastroenterology Tests and Procedures in the U.S | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Price Comparison for Gastroenterology Tests and Procedures in the U.S Kevin Brittan, Kyle Scholten DO, Jason Barbaretta, Patrick Twohig, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4069380/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: After The Hospital Price Transparency Final Rule, hospitals were required to post prices for all services with the goal of increasing transparency and clarity for patients undergoing medical tests and evaluations. This data presents the opportunity to analyze variation in prices for commonly performed tests and procedures. We aimed to assess availability of price information and differences in reported costs per procedure of the most common gastroenterology and hepatology tests and procedures. Methods: Hospital chargemasters were analyzed for the top 20 rated hospitals and top 20 rated gastroenterology and gastrointestinal surgery hospitals according to US News Report Weekly 1 , 2 . Twenty-five hospitals were included in total. Median self-pay price was obtained for the following procedures: ultrasound abdomen, computed tomography abdomen with contrast, magnetic resonance imaging abdomen with contrast, liver elastography, esophagogastroduodenoscopy, colonoscopy, liver biopsy, as well as pathology fees for specimens from EGD, colonoscopy, and liver biopsy. Results: All hospitals included in the study reported service costs online. However, only 8% of these hospitals reported the cost of all procedures investigated. Significant cost variation was seen in all procedures. An esophagogastroduodenoscopy had a 51-fold difference in cost in reported price between hospitals, and a colonoscopy similarly was found to have greater than an 80-fold difference. Conclusion: Despite The Hospital Price Transparency Final Rule, the availability of costs for gastroenterology medical tests and procedures are not readily accessible or transparent. Of these reported costs, we found notable price discrepancies, and further studies are needed to investigate similar patterns across different insurance payers. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction: In 2021, The Hospital Price Transparency Final Rule was developed, requiring hospitals to post prices for all services including tests and procedures. Making this data publicly available was designed to create transparency better understand healthcare costs, and leverage market dynamics to create lower costs for patients and healthcare systems. Making this data publicly available also provides a unique opportunity to analyze variation in negotiated prices for commonly performed tests and procedures. An assessment of commonly performed cardiovascular tests at top ranked United States (US) hospitals identified significant cost variation both between and within institutions among different payers 1 . To our knowledge, this type of analysis has not been applied to commonly performed gastrointestinal (GI) procedures and tests. Our aim is to compare prices for commonly performed GI tests and procedures among hospitals in the US. Methods: We performed a cross-sectional study by searching the hospital chargemaster web sites of the top 20 rated hospitals and top 20 rated gastroenterology and Gastrointestinal surgery hospitals by US News and World Report in 2022. (A total of 4 additional hospitals were added from the latter list.) 2 , 3 The hospital chargemaster is a collection of standard negotiated prices for hospital services including tests, procedures, prescriptions, and are similar to a manufacturer’s suggested retail price for other goods and services on the market in any other industry. We evaluated for the median negotiated self-pay price for the following GI tests/procedures using current procedural terminology codes: ultrasound abdomen (complete including doppler), Computed tomography (CT) abdomen with contrast, magnetic resonance imaging (MRI) abdomen with contrast, liver elastography, Esophagogastroduodenoscopy (EGD), colonoscopy, liver biopsy (percutaneous vs transjugular), as well as pathology fees for processing specimens from EGD, colonoscopy, and liver biopsy. Since all hospital chargemaster websites require the input of a unique individual insurance plan and demographic data to evaluate payer-specific negotiated prices, we used “self-pay” as a price comparator across all hospitals for this study. Institutional Review Board approval was not required because we used publicly available data that did not include patient information. Analyses were performed from September 15th, 2022, until September 30th, 2022. Statistical analysis for significance used the Shapiro-Wilks test and Grubbs’ test to assess normality and univariant outliers. Results: Of the top 20 US hospitals, 100% (25/25) posted chargemaster prices, and only 8% (2/25) reported prices for all GI tests and procedures (Fig. 1 ). For colonoscopy, a total of 24 out of 25 hospitals reported prices. The average price was $ 7,466 with a standard deviation of $ 7800. The prices ranged from $ 440 to $ 36,708 with an IQR of $ 5,049.94. Distribution was non-normal (P < 0.001). Hospitals of the University of Pennsylvania were an outlier (P < 0.05). After eliminating this outlier, the average price was $ 5,729, IQR was $ 5,587, and the standard deviation was $ 4436 (Fig. 2 ). For EGD, all hospitals reported prices with an average price of $ 7,150 and a standard deviation of $ 8325. Prices ranged from $ 440 to $ 36,708, and IQR was $ 6,242. Distribution was non-normal (P < 0.001) with UPMC Presbyterian Shadyside as an outlier (P value < 0.05). After elimination, the average price was $ 5,729, IQR was $ 5,587, and the standard deviation was $ 4436 (Fig. 3 ). For radiologic procedures, CT abdomen with contrast price was reported in all hospitals. The average price was $ 2,957 with a standard deviation of $ 1866. Prices ranged from $ 1,181 to $ 6,960 with an IQR of $ 2,092. Distribution was non-normal (P < 0.01). University of Chicago and UPMC Presbyterian Shadyside were outliers (P values < 0.05). After eliminating both outliers, the average price was $ 2,549, IQR was $ 1,420, and the standard deviation was $ 1253. Price was reported for MRI abdomen with contrast in 24 of 25 hospitals. The average price was $ 4,231 with a standard deviation of $ 1866. Prices ranged from $ 623 to $ 8,278 with an IQR of $ 1,881. For complete abdominal ultrasound, prices were reported in all hospitals. The average price was $ 1,029 with a standard deviation of $ 523. Prices ranged from $ 142 to $ 2,655 with an IQR of $ 611. Liver elastography prices were reported in 8 of 25 hospitals. The average price was $ 485 with a standard deviation of $ 295. Prices ranged from $ 175 to $ 1,099, and IQR was $ 290. Liver biopsy prices were reported in 16 of 25 hospitals. The average price was average $ 5,401 with a standard deviation of $ 3,481. Prices ranged from $ 374 to $ 11,579 with an IQR of $ 3,784. Lastly, pathology results were not widely available but ranged from $ 259 to $ 1,094 depending on the level of complexity (Fig. 4 ). Discussion: We found that prices for the most common gastroenterology and hepatology procedures significantly vary across the top 25 GI hospitals in the US. For EGD and colonoscopy, the standard deviation across the study was greater than the average reported self-pay price with standard deviations of $ 7800 and $ 8325, respectively. Furthermore, there was a 51-fold difference found in the price for an EGD and greater than an 80-fold difference for a colonoscopy. In the analysis, significant outliers were found in multiple procedures. Interestingly, these outliers were not the same institution with repeat occurrences. Instead, it was multiple hospitals with one or two significantly elevated prices. Therefore, we suspect the degree of variation in prices demonstrated was not secondary to a few hospitals with high prices rather variation was present systematically. Considering the Hospital Price Transparency Final Rule, hospitals must legally post prices for all tests and procedures. Despite these hospitals being chosen for their exemplary care as well as their well-funded programs, only two of the 25 hospitals in this study met this requirement. Of the procedures of interest, EGD, CT abdomen with contrast, and complete abdominal ultrasound were the only tests to have prices available at all institutions. Colonoscopy prices similarly was reported in 24 of 25 hospitals. Ultimately, 92% of the hospitals included in this review failed to meet the requirement of providing prices for all procedures despite legal requirements for reporting. We also found that transparency is limited by accessibility to this data. Some hospitals used simple patient-friendly websites with easy access to procedure information including price estimates, while others did not have this information available at all, or it was behind multiple menus of a website. These unfriendly forms may meet legal requirements for public display of pricing but ultimately undercut the objective of transparency for patients. The inaccessibility aforementioned largely impacted this analysis. Individual insurance plans, Medicare, and Medicaid prices had substantial barriers to information gathering. For example, the large majority of individual insurance plans are locked behind payer ID. Additionally, Medicare estimates provided by the US Federal Government include national averages and do not include true prices regarding procedures. Lastly, Medicaid is a state implemented program which results in variability of out-of-pocket costs state by state. Overall, all of these factors and other barriers to collecting data outside of cash pay price became unsurmountable for a national price analysis. These gastroenterology tests and procedures place a significant economic burden on the US. Annual healthcare expenditures for gastroenterology are estimated to be 135 billion annually in the United States 4 . This is greater than heart disease, trauma, or mental illness expenditures 5 . The vast disparity in prices negatively impacts patient burden and our health care system as a whole. An estimated 11 million colonoscopies and 6.1 million upper endoscopies are estimated annually 4 . The 80-fold and 50-fold difference in prices equates to billions spent across our system due to facility selection alone. In this study, the grouping of hospitals is likely of similar quality. However, prices for self-pay vary significantly. Reasons for this are complex, and could include market variability, non-clinical related costs such as facility fees, among others. Policies to make negotiated prices for tests/procedures more transparent and easily trackable are needed, especially as the US health care system becomes more complex and new tests/procedures become available. This is a complex issue but given the significant variation in pricing for standardized procedures, this is worth further evaluation with the intention of not only lowering costs but understanding how prices are set and the dynamics at play regarding reimbursement and actual payment. Given the significant expenditures that occur in US health care, making prices more consistent for patients regardless of their pay source is needed. This study has several limitations. First, the findings are a direct representation of the quality and accuracy of data posted by hospitals. Data within the chargemaster websites for each hospital was variable, which limited the ability to make as many price comparisons as possible across different institutions. Second, our analysis was restricted to self-pay, so we could not make comparisons in cost between different payer sources. Although the chargemaster data is publicly available, unique patient insurance information is needed to obtain prices for different insurance providers, which was not possible for the purposes of this study. Finally, prices do not specify whether professional fees are included and did not account for variations in pricing between inpatient/outpatient or screening/diagnostic tests. The data presented brings up new areas for analysis in the push for more price transparency in the United States. One of the most interesting applications would be the analysis of smaller or more localized hospital systems in the United States. Given the large resources of the hospital system included in the analysis, investigating if smaller hospitals with relatively less resources are also struggling to provide transparency to their patient populations would provide interesting insight into transparency implementation. Additionally, these results should be compared to the costs that private insurers, Medicare, and Medicaid pay as well as the individual patient. Lastly, the transparency of the prices provided should be compared on an annual basis to affirm the further implementation of the Hospital Transparency Final Rule. This study demonstrated the high variation in the cost of gastroenterology tests and procedures across the top 25 hospitals in the United States. Although price transparency laws have enabled access to some reported prices, their limitations in accessing this data for all procedures. Further studies will be needed to confirm these findings in private insurers and the government-directed health insurance programs Declarations: Author Contribution KB, KS, JB - data collection and first draft of manuscriptPT - data analysis and manuscript reviewFR - Manuscript review References: Oseran AS, Ati S, Feldman WB, Gondi S, Yeh RW, Wadhera RK. Assessment of Prices for Cardiovascular Tests and Procedures at Top-Ranked US Hospitals. JAMA Internal Medicine 2022;182(9):996–999. America's Best Hospitals: the 2022–2023 Honor Roll and Overview. US News & World Report, July 2022. ( https://health.usnews.com/health-care/best-hospitals/articles/best-hospitals-honor-roll-and-overview) Best Hospitals for Gastroenterology & GI Surgery. US News & World Report, 2022. ( https://health.usnews.com/best-hospitals/rankings/gastroenterology-and-gi-surgery ) Peery AF, Crockett SD, Murphy CC, Lund JL, Dellon ES, Williams JL, Jensen ET, Shaheen NJ, Barritt AS, Lieber SR, Kochar B, Barnes EL, Fan YC, Pate V, Galanko J, Baron TH, Sandler RS. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018. Gastroenterology. 2019;156(1):254–272.e11. doi: 10.1053/j.gastro.2018.08.063 . Epub 2018 Oct 10. Erratum in: Gastroenterology. 2019;156(6):1936. PMID: 30315778; PMCID: PMC6689327. Agency for Healthcare Research and Quality. Total expenditures in millions by condition, United States, 2015. Medical Expenditure Panel Survey Generated interactively: July 26, 2018. Additional Declarations No competing interests reported. Supplementary Files DDSSupplementalHospitalCostTables.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4069380","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":278881877,"identity":"561331d1-991b-4b31-b0af-edcf03fc1b26","order_by":0,"name":"Kevin Brittan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYBACCQkGhgMgBj9UgLGBKC0HEhgYJBtI0cIA0mJwgFgtkrN7Hx7++MMuz/hG7tENPxhsZDccIKBFWua4AdBhycVmN/LSbvYwpBkT1CInkQbyC3Piths5ZrcZGA4nEqulPnHzDLCW/4S1SEO0AA2XAGs5QFiL5JxjDAfOpB1PnHHmjdnNHoNk45mEtEjcbmP+UGFTndjfnmN240eFnWwfIS1owIA05aNgFIyCUTAKcAAA2aFKIktndPwAAAAASUVORK5CYII=","orcid":"","institution":"University of Nebraska Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Kevin","middleName":"","lastName":"Brittan","suffix":""},{"id":278881878,"identity":"1ef4cbc0-fa92-4910-b4e7-b172b1852dd5","order_by":1,"name":"Kyle Scholten DO","email":"","orcid":"","institution":"University of Nebraska Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Kyle","middleName":"Scholten","lastName":"DO","suffix":""},{"id":278881879,"identity":"eda44b4d-ee65-4fe8-82de-2f16990b2f23","order_by":2,"name":"Jason 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03:44:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4069380/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4069380/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52705125,"identity":"5d673f38-ad18-46c0-8781-883f9aae4174","added_by":"auto","created_at":"2024-03-14 18:41:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":317760,"visible":true,"origin":"","legend":"\u003cp\u003eBox plot of procedure versus cost of gastroenterology and hepatology procedures at the top 20 gastroenterology hospitals.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4069380/v1/20f7d0091eea9294ba88814b.png"},{"id":52705123,"identity":"8cf3b177-f1f9-4bd3-8d64-20e32e13beef","added_by":"auto","created_at":"2024-03-14 18:41:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":200043,"visible":true,"origin":"","legend":"\u003cp\u003eCost comparison of outpatient colonoscopy with vertical line representative of mean cost.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4069380/v1/2879eccfcef62b8e04b37ed2.png"},{"id":52705856,"identity":"506c6302-dcd7-4e3f-93fb-ff90d369d199","added_by":"auto","created_at":"2024-03-14 18:49:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":150832,"visible":true,"origin":"","legend":"\u003cp\u003eCost comparison of outpatient esophagogastroduodenoscopy (EGD) with vertical line representative of mean cost.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4069380/v1/b72389aa22350201f294a6d2.png"},{"id":52705128,"identity":"2183c4b2-1d87-4922-93e9-89b7b26f2bb1","added_by":"auto","created_at":"2024-03-14 18:41:09","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":144859,"visible":true,"origin":"","legend":"\u003cp\u003eCost comparison of liver biopsy with vertical line representative of mean cost.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4069380/v1/c3fcd98d9e7ac7106a333309.png"},{"id":59124534,"identity":"09da3f72-e5c4-42a7-a117-b9282642bcd8","added_by":"auto","created_at":"2024-06-26 15:22:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":866499,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4069380/v1/f80bfebf-ffde-4616-9d92-b40c6f1da3d8.pdf"},{"id":52706019,"identity":"875eed35-f773-4f15-bc31-fd4a4eed5561","added_by":"auto","created_at":"2024-03-14 18:57:09","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":11789,"visible":true,"origin":"","legend":"","description":"","filename":"DDSSupplementalHospitalCostTables.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4069380/v1/4e0f86e2b561797c5788a556.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Price Comparison for Gastroenterology Tests and Procedures in the U.S","fulltext":[{"header":"Introduction:","content":"\u003cp\u003eIn 2021, The Hospital Price Transparency Final Rule was developed, requiring hospitals to post prices for all services including tests and procedures. Making this data publicly available was designed to create transparency better understand healthcare costs, and leverage market dynamics to create lower costs for patients and healthcare systems. Making this data publicly available also provides a unique opportunity to analyze variation in negotiated prices for commonly performed tests and procedures. An assessment of commonly performed cardiovascular tests at top ranked United States (US) hospitals identified significant cost variation both between and within institutions among different payers\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. To our knowledge, this type of analysis has not been applied to commonly performed gastrointestinal (GI) procedures and tests. Our aim is to compare prices for commonly performed GI tests and procedures among hospitals in the US.\u003c/p\u003e"},{"header":"Methods:","content":"\u003cp\u003eWe performed a cross-sectional study by searching the hospital chargemaster web sites of the top 20 rated hospitals and top 20 rated gastroenterology and Gastrointestinal surgery hospitals by US News and World Report in 2022. (A total of 4 additional hospitals were added from the latter list.)\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The hospital chargemaster is a collection of standard negotiated prices for hospital services including tests, procedures, prescriptions, and are similar to a manufacturer\u0026rsquo;s suggested retail price for other goods and services on the market in any other industry.\u003c/p\u003e \u003cp\u003eWe evaluated for the median negotiated self-pay price for the following GI tests/procedures using current procedural terminology codes: ultrasound abdomen (complete including doppler), Computed tomography (CT) abdomen with contrast, magnetic resonance imaging (MRI) abdomen with contrast, liver elastography, Esophagogastroduodenoscopy (EGD), colonoscopy, liver biopsy (percutaneous vs transjugular), as well as pathology fees for processing specimens from EGD, colonoscopy, and liver biopsy.\u003c/p\u003e \u003cp\u003eSince all hospital chargemaster websites require the input of a unique individual insurance plan and demographic data to evaluate payer-specific negotiated prices, we used \u0026ldquo;self-pay\u0026rdquo; as a price comparator across all hospitals for this study. Institutional Review Board approval was not required because we used publicly available data that did not include patient information. Analyses were performed from September 15th, 2022, until September 30th, 2022. Statistical analysis for significance used the Shapiro-Wilks test and Grubbs\u0026rsquo; test to assess normality and univariant outliers.\u003c/p\u003e"},{"header":"Results:","content":"\u003cp\u003eOf the top 20 US hospitals, 100% (25/25) posted chargemaster prices, and only 8% (2/25) reported prices for all GI tests and procedures (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). For colonoscopy, a total of 24 out of 25 hospitals reported prices. The average price was \u003cspan\u003e$\u003c/span\u003e7,466 with a standard deviation of \u003cspan\u003e$\u003c/span\u003e7800. The prices ranged from \u003cspan\u003e$\u003c/span\u003e440 to \u003cspan\u003e$\u003c/span\u003e36,708 with an IQR of \u003cspan\u003e$\u003c/span\u003e5,049.94. Distribution was non-normal (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Hospitals of the University of Pennsylvania were an outlier (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). After eliminating this outlier, the average price was \u003cspan\u003e$\u003c/span\u003e5,729, IQR was \u003cspan\u003e$\u003c/span\u003e5,587, and the standard deviation was \u003cspan\u003e$\u003c/span\u003e4436 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor EGD, all hospitals reported prices with an average price of \u003cspan\u003e$\u003c/span\u003e7,150 and a standard deviation of \u003cspan\u003e$\u003c/span\u003e8325. Prices ranged from \u003cspan\u003e$\u003c/span\u003e440 to \u003cspan\u003e$\u003c/span\u003e36,708, and IQR was \u003cspan\u003e$\u003c/span\u003e6,242. Distribution was non-normal (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with UPMC Presbyterian Shadyside as an outlier (P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). After elimination, the average price was \u003cspan\u003e$\u003c/span\u003e5,729, IQR was \u003cspan\u003e$\u003c/span\u003e5,587, and the standard deviation was \u003cspan\u003e$\u003c/span\u003e4436 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor radiologic procedures, CT abdomen with contrast price was reported in all hospitals. The average price was \u003cspan\u003e$\u003c/span\u003e2,957 with a standard deviation of \u003cspan\u003e$\u003c/span\u003e1866. Prices ranged from \u003cspan\u003e$\u003c/span\u003e1,181 to \u003cspan\u003e$\u003c/span\u003e6,960 with an IQR of \u003cspan\u003e$\u003c/span\u003e2,092. Distribution was non-normal (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). University of Chicago and UPMC Presbyterian Shadyside were outliers (P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05). After eliminating both outliers, the average price was \u003cspan\u003e$\u003c/span\u003e2,549, IQR was \u003cspan\u003e$\u003c/span\u003e1,420, and the standard deviation was \u003cspan\u003e$\u003c/span\u003e1253. Price was reported for MRI abdomen with contrast in 24 of 25 hospitals. The average price was \u003cspan\u003e$\u003c/span\u003e4,231 with a standard deviation of \u003cspan\u003e$\u003c/span\u003e1866. Prices ranged from \u003cspan\u003e$\u003c/span\u003e623 to \u003cspan\u003e$\u003c/span\u003e8,278 with an IQR of \u003cspan\u003e$\u003c/span\u003e1,881. For complete abdominal ultrasound, prices were reported in all hospitals. The average price was \u003cspan\u003e$\u003c/span\u003e1,029 with a standard deviation of \u003cspan\u003e$\u003c/span\u003e523. Prices ranged from \u003cspan\u003e$\u003c/span\u003e142 to \u003cspan\u003e$\u003c/span\u003e2,655 with an IQR of \u003cspan\u003e$\u003c/span\u003e611.\u003c/p\u003e \u003cp\u003eLiver elastography prices were reported in 8 of 25 hospitals. The average price was \u003cspan\u003e$\u003c/span\u003e485 with a standard deviation of \u003cspan\u003e$\u003c/span\u003e295. Prices ranged from \u003cspan\u003e$\u003c/span\u003e175 to \u003cspan\u003e$\u003c/span\u003e1,099, and IQR was \u003cspan\u003e$\u003c/span\u003e290. Liver biopsy prices were reported in 16 of 25 hospitals. The average price was average \u003cspan\u003e$\u003c/span\u003e5,401 with a standard deviation of \u003cspan\u003e$\u003c/span\u003e3,481. Prices ranged from \u003cspan\u003e$\u003c/span\u003e374 to \u003cspan\u003e$\u003c/span\u003e11,579 with an IQR of \u003cspan\u003e$\u003c/span\u003e3,784. Lastly, pathology results were not widely available but ranged from \u003cspan\u003e$\u003c/span\u003e259 to \u003cspan\u003e$\u003c/span\u003e1,094 depending on the level of complexity (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion:","content":"\u003cp\u003eWe found that prices for the most common gastroenterology and hepatology procedures significantly vary across the top 25 GI hospitals in the US. For EGD and colonoscopy, the standard deviation across the study was greater than the average reported self-pay price with standard deviations of \u003cspan\u003e$\u003c/span\u003e7800 and \u003cspan\u003e$\u003c/span\u003e8325, respectively. Furthermore, there was a 51-fold difference found in the price for an EGD and greater than an 80-fold difference for a colonoscopy. In the analysis, significant outliers were found in multiple procedures. Interestingly, these outliers were not the same institution with repeat occurrences. Instead, it was multiple hospitals with one or two significantly elevated prices. Therefore, we suspect the degree of variation in prices demonstrated was not secondary to a few hospitals with high prices rather variation was present systematically.\u003c/p\u003e \u003cp\u003eConsidering the Hospital Price Transparency Final Rule, hospitals must legally post prices for all tests and procedures. Despite these hospitals being chosen for their exemplary care as well as their well-funded programs, only two of the 25 hospitals in this study met this requirement. Of the procedures of interest, EGD, CT abdomen with contrast, and complete abdominal ultrasound were the only tests to have prices available at all institutions. Colonoscopy prices similarly was reported in 24 of 25 hospitals. Ultimately, 92% of the hospitals included in this review failed to meet the requirement of providing prices for all procedures despite legal requirements for reporting.\u003c/p\u003e \u003cp\u003eWe also found that transparency is limited by accessibility to this data. Some hospitals used simple patient-friendly websites with easy access to procedure information including price estimates, while others did not have this information available at all, or it was behind multiple menus of a website. These unfriendly forms may meet legal requirements for public display of pricing but ultimately undercut the objective of transparency for patients.\u003c/p\u003e \u003cp\u003eThe inaccessibility aforementioned largely impacted this analysis. Individual insurance plans, Medicare, and Medicaid prices had substantial barriers to information gathering. For example, the large majority of individual insurance plans are locked behind payer ID. Additionally, Medicare estimates provided by the US Federal Government include national averages and do not include true prices regarding procedures. Lastly, Medicaid is a state implemented program which results in variability of out-of-pocket costs state by state. Overall, all of these factors and other barriers to collecting data outside of cash pay price became unsurmountable for a national price analysis.\u003c/p\u003e \u003cp\u003eThese gastroenterology tests and procedures place a significant economic burden on the US. Annual healthcare expenditures for gastroenterology are estimated to be 135\u0026nbsp;billion annually in the United States\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. This is greater than heart disease, trauma, or mental illness expenditures\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The vast disparity in prices negatively impacts patient burden and our health care system as a whole. An estimated 11\u0026nbsp;million colonoscopies and 6.1\u0026nbsp;million upper endoscopies are estimated annually\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. The 80-fold and 50-fold difference in prices equates to billions spent across our system due to facility selection alone. In this study, the grouping of hospitals is likely of similar quality. However, prices for self-pay vary significantly. Reasons for this are complex, and could include market variability, non-clinical related costs such as facility fees, among others. Policies to make negotiated prices for tests/procedures more transparent and easily trackable are needed, especially as the US health care system becomes more complex and new tests/procedures become available. This is a complex issue but given the significant variation in pricing for standardized procedures, this is worth further evaluation with the intention of not only lowering costs but understanding how prices are set and the dynamics at play regarding reimbursement and actual payment. Given the significant expenditures that occur in US health care, making prices more consistent for patients regardless of their pay source is needed.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the findings are a direct representation of the quality and accuracy of data posted by hospitals. Data within the chargemaster websites for each hospital was variable, which limited the ability to make as many price comparisons as possible across different institutions. Second, our analysis was restricted to self-pay, so we could not make comparisons in cost between different payer sources. Although the chargemaster data is publicly available, unique patient insurance information is needed to obtain prices for different insurance providers, which was not possible for the purposes of this study. Finally, prices do not specify whether professional fees are included and did not account for variations in pricing between inpatient/outpatient or screening/diagnostic tests.\u003c/p\u003e \u003cp\u003eThe data presented brings up new areas for analysis in the push for more price transparency in the United States. One of the most interesting applications would be the analysis of smaller or more localized hospital systems in the United States. Given the large resources of the hospital system included in the analysis, investigating if smaller hospitals with relatively less resources are also struggling to provide transparency to their patient populations would provide interesting insight into transparency implementation. Additionally, these results should be compared to the costs that private insurers, Medicare, and Medicaid pay as well as the individual patient. Lastly, the transparency of the prices provided should be compared on an annual basis to affirm the further implementation of the Hospital Transparency Final Rule.\u003c/p\u003e \u003cp\u003eThis study demonstrated the high variation in the cost of gastroenterology tests and procedures across the top 25 hospitals in the United States. Although price transparency laws have enabled access to some reported prices, their limitations in accessing this data for all procedures. Further studies will be needed to confirm these findings in private insurers and the government-directed health insurance programs\u003c/p\u003e"},{"header":"Declarations:","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKB, KS, JB - data collection and first draft of manuscriptPT - data analysis and manuscript reviewFR - Manuscript review\u003c/p\u003e"},{"header":"References:","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOseran AS, Ati S, Feldman WB, Gondi S, Yeh RW, Wadhera RK. Assessment of Prices for Cardiovascular Tests and Procedures at Top-Ranked US Hospitals. JAMA Internal Medicine 2022;182(9):996\u0026ndash;999.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerica's Best Hospitals: the 2022\u0026ndash;2023 Honor Roll and Overview. US News \u0026amp; World Report, July 2022. (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://health.usnews.com/health-care/best-hospitals/articles/best-hospitals-honor-roll-and-overview)\u003c/span\u003e\u003cspan address=\"https://health.usnews.com/health-care/best-hospitals/articles/best-hospitals-honor-roll-and-overview)\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBest Hospitals for Gastroenterology \u0026amp; GI Surgery. US News \u0026amp; World Report, 2022. (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://health.usnews.com/best-hospitals/rankings/gastroenterology-and-gi-surgery\u003c/span\u003e\u003cspan address=\"https://health.usnews.com/best-hospitals/rankings/gastroenterology-and-gi-surgery\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeery AF, Crockett SD, Murphy CC, Lund JL, Dellon ES, Williams JL, Jensen ET, Shaheen NJ, Barritt AS, Lieber SR, Kochar B, Barnes EL, Fan YC, Pate V, Galanko J, Baron TH, Sandler RS. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018. Gastroenterology. 2019;156(1):254\u0026ndash;272.e11. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/j.gastro.2018.08.063\u003c/span\u003e\u003cspan address=\"10.1053/j.gastro.2018.08.063\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2018 Oct 10. Erratum in: Gastroenterology. 2019;156(6):1936. PMID: 30315778; PMCID: PMC6689327.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgency for Healthcare Research and Quality. Total expenditures in millions by condition, United States, 2015. Medical Expenditure Panel Survey Generated interactively: July 26, 2018.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4069380/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4069380/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eAfter The Hospital Price Transparency Final Rule, hospitals were required to post prices for all services with the goal of increasing transparency and clarity for patients undergoing medical tests and evaluations. This data presents the opportunity to analyze variation in prices for commonly performed tests and procedures. We aimed to assess availability of price information and differences in reported costs per procedure of the most common gastroenterology and hepatology tests and procedures.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eHospital chargemasters were analyzed for the top 20 rated hospitals and top 20 rated gastroenterology and gastrointestinal surgery hospitals according to US News Report Weekly\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Twenty-five hospitals were included in total. Median self-pay price was obtained for the following procedures: ultrasound abdomen, computed tomography abdomen with contrast, magnetic resonance imaging abdomen with contrast, liver elastography, esophagogastroduodenoscopy, colonoscopy, liver biopsy, as well as pathology fees for specimens from EGD, colonoscopy, and liver biopsy.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eAll hospitals included in the study reported service costs online. However, only 8% of these hospitals reported the cost of all procedures investigated. Significant cost variation was seen in all procedures. An esophagogastroduodenoscopy had a 51-fold difference in cost in reported price between hospitals, and a colonoscopy similarly was found to have greater than an 80-fold difference.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eDespite The Hospital Price Transparency Final Rule, the availability of costs for gastroenterology medical tests and procedures are not readily accessible or transparent. Of these reported costs, we found notable price discrepancies, and further studies are needed to investigate similar patterns across different insurance payers.\u003c/p\u003e","manuscriptTitle":"Price Comparison for Gastroenterology Tests and Procedures in the U.S","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-14 18:41:04","doi":"10.21203/rs.3.rs-4069380/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e704e29-263b-473d-8ca3-1b34ea6d259a","owner":[],"postedDate":"March 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-26T15:14:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-14 18:41:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4069380","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4069380","identity":"rs-4069380","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}