Price Transparency Analysis of MRI IAC for Vestibular Schwannoma

Introduction: The federal mandate for price transparency empowers patients with price information and can have major implications on patients seeking oncologic treatment and surveillance care. This research seeks to characterize the national price variability associated with surveillance imaging protocols for patients with vestibular schwannoma.

Methods: A cross-sectional analysis of hospital chargemasters including prices for each CPT code was performed for high-volume neurotology centers, as indicated by the presence of a neurotology fellowship. Each hospital’s gross charge for MRI IAC (CPT 70553) was correlated with geographic practice cost indexes (GPCI) to adjust for location and determine a standardized cost value, which were used for comparative analysis.

Results: Of the 27 active neurotology fellowship centers, 24 (89%) published accessible chargemaster files in 2022. When adjusted for GPCI, standardized charges for MRI IAC protocol ranged from $1124.29 to $14812.56, with a mean of $5680.63, amounting to 16.4 times the valuation of Center for Medicare and Medicaid Services facility-based reimbursement ($346.41). Regionally, net charges were lower in Midwest and South regions at $4,832.81 and $4,895.14, compared to the Northeast and West, which were $6,941.99 and $6,632.41, respectively. For patients undergoing observation, we estimate the total cost burden in surveillance to potentially climb up to $90,890, if consistent with guidelines for disease surveillance. Similarly, even those who undergo surgical resection and normal post-operative course, in addition to the cost of their surgical episode, the average cost of imaging alone is $22,722.52.

Conclusions: An MRI IAC is an expensive test for patients, especially those that require surveillance for decades following initial diagnosis. Our data show that there is significant geographic variability in costs of MRI IAC imaging for vestibular schwannoma patients. While this may not reflect insurance-negotiated rates, price-transparency enables otologic patients to make data-driven decisions as to where to seek their care for surveillance imaging.