Negotiated Prices for Reconstructive Surgery Converge without Reduction in Overall Price Level after Federal Price Transparency Regulations

BACKGROUND: Federal price transparency regulations require disclosure of negotiated commercial prices, but whether these policies improve affordability for reconstructive surgery remains uncertain. We evaluated post-regulation changes in negotiated prices, price convergence, price variation, and overall inflation-adjusted price levels. STUDY DESIGN: Retrospective longitudinal observational study of nationwide hospital price transparency data (December 2021-June 2024). Facility rates for 125 reconstructive surgery CPT codes were linked across 403 hospitals, 51 core-based statistical areas, and four national commercial insurers, yielding 496,868 observations and 16,028 negotiated rate groups. Annualized real rate change (ARRC) was modeled using linear mixed-effects regression with hospitals nested within geographic markets, adjusting for initial within-market price percentile, service category, payer, and market structure. RESULTS: Prices converged in 677 of 886 local markets (76.4%), with the gap between high- and low-priced hospitals narrowing by 13.4 percentage points annually. Overall inflation-adjusted negotiated prices remained stable (ARRC intercept -0.012; p=0.289). Price dispersion showed no robust directional change. Greater convergence was observed among initially higher-priced hospitals, with significant variation by payer and service category but not market structure. Hospital-level heterogeneity explained substantially more variance than measured covariates (conditional R² 0.577; marginal R² 0.132; hospital ICC 0.326). Convergence remained consistent across multiple sensitivity analyses. CONCLUSIONS: Following implementation of price transparency regulations, negotiated prices for reconstructive surgery services converged between high- and low-priced hospitals without meaningful changes in overall inflation-adjusted price levels or price variation. These findings suggest that transparency alone is unlikely to improve affordability and should be complemented by additional policy strategies targeting healthcare costs.