The Reality of BPH Surgery Price and Reimbursement Across Top U.S. Hospitals

INTRODUCTION AND OBJECTIVES: A growing number of surgical treatments are available for benign prostatic hyperplasia (BPH), each with distinct clinical profiles and resource demands. Wide variations in cost and reimbursement are understood to exist due to hospital-insurer negotiations, but are rarely quantified. The 2021 Medicare Price Transparency Final Rule now provides publicly available pricing data, allowing objective evaluation of real-world costs. We used these data to assess hospital charges and commercial reimbursement for common BPH procedures. METHODS: Charges and commercial reimbursement were obtained from the Turquoise Health database, which compiles pricing reported under Medicare transparency regulations. We analyzed procedure type, hospital, payer class, and service location among US News Top 20 hospitals. RESULTS: Charges varied by procedure, highest median charge associated with transurethral waterjet ablation [$15,742 ($11,281-$27,707)] and lowest for prostatic urethral lift [$4,489 ($1,228-$46,289)]. Private insurers were associated with higher charges. Significant inter-hospital variation was observed for prostatic urethral lift (p<0.001) and transurethral waterjet ablation (p<0.05). On multivariate analysis, hospital and payer predicted charges, while procedure type did not. Reimbursement also varied, highest median reimbursement was associated with transurethral waterjet ablation [$12,476.49 ($8938.33- $29,208.64] and lowest for transurethral resection of the prostate [$4,258.94 ($2,889.88-$40,949.00). Variation was driven by procedure type and care setting, but not institution. CONCLUSIONS: Substantial variation in BPH procedure pricing and reimbursement persists across top-ranked hospitals despite Medicare's price transparency regulations. Price variation appears more influenced by non-procedural factors, highlighting inequities in institutional negotiations and the need for further evaluation of hospital pricing patterns.