Payer-Negotiated Prices in the Diagnosis and Management of Cutaneous Melanoma in 2025.

Abstract

The 2021 Federal Hospital Price Transparency Final Rule requires hospitals to publicly disclose payer-negotiated prices for services. Despite rising cutaneous melanoma incidence and strong association with geographic ultraviolet light exposure, price transparency for melanoma-specific care is incompletely understood. We assessed regional price compliance and variation among National Cancer Institute-designated Comprehensive Cancer Centers (NCI-CCCs) to inform clinician-patient cost discussions. A cross-sectional analysis was conducted of private payer-specific negotiated prices in 2025 for 53 melanoma-related procedures using publicly available hospital price transparency files. Fifty-eight NCI-CCCs providing adult clinical care were included (data extracted January 1-March 31, 2025). Primary outcomes were markups relative to Medicare reimbursement and price dispersion across and within centers by billing code. Secondary outcomes included compliance with price transparency, markups, and price dispersion by US Census division. Overall, 47/58 centers (81.0%) were federally compliant, with lymph node procedures showing the highest median (IQR) markups relative to Medicare 7.9 (5.5-9.5). Diagnostic testing/imaging demonstrated the greatest price dispersion, with median (IQR) across-center and within-center ratios of 13.4 (9.5-16.6) and 11.2 (9.6-12.7), respectively. The Pacific division had the highest median price markups at 8.9 (3.7-13.4) and included five noncompliant centers. Across divisions, within- and across-center price dispersion were strongly correlated (ρ = 0.88; 95% CI, 0.53 to 1.00). The use of lymph node procedures, diagnostic testing, and imaging presents a key opportunity to mitigate financial toxicity for at-risk patients. Improved clinical accessibility of pricing data and policy intervention is still needed to advance patient-centered, value-driven care.