The Price of Otologic Procedures: Variation in Markup by Surgical Procedure and Geography in the United States

Daniel D. Bu, Zachary G. Schwam, Sean N. Neifert, Rocco Ferrandino, Vivian Z. Kaul, Enrique Perez, George B. Wanna, Maura K. Cosetti

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective:To characterize and analyze variation in price markup of seven common otologic surgeries by procedure and geographic region.Study Design:Retrospective Analysis of the Centers for Medicare and Medicaid Services database of 2017 Medicare Provider Utilization and Payment Public File.Setting:Inpatient and outpatient centers delivering Medicare-reimbursed services.Patients:Full sample of patients undergoing procedures with Medicare fee-for-service final action claims during 2017.Interventions:Seven procedures (myringotomy, tympanoplasty, mastoidectomy, tympanomastoidectomy stapedotomy/stapedectomy, cochlear implant, bone-anchored hearing aid).Main Outcome Measures:Markup ratio (MUR) is defined as the ratio of total charges to Medicare-allowable-costs; Variation in MUR was measured using coefficient of variation (CoV).Results:Among all providers, the median MUR was 2.4 (interquartile range: 1.9-3.1). MUR varied significantly by procedure, from 2.3 for myringotomy to 8.7 for mastoidectomy (p < 0.01). MUR also varied significantly within procedure, with the least variation found in myringotomy (CoV = 0.46), and the greatest in cochlear implants (CoV = 0.92). Using the national average as baseline, MUR varied 71% between states, ranging from 1.75 to 6.24. Within the same state, significant variation was also noted, varying by 4% (CoV = 0.04) in Montana compared with 138% (CoV = 1.38) in Pennsylvania. MUR was not significantly correlated with patient comorbidity or Centers for Medicare and Medicaid Services risk scores.Conclusions:There was significant variation in the price of otologic surgery across geographic regions and procedures. The MUR for otology is lower or comparable to that reported in other surgical fields.

Original languageEnglish
Pages (from-to)1184-1191
Number of pages8
JournalOtology and Neurotology
Issue number8
StatePublished - 1 Sep 2021


  • Boneanchored hearing aid
  • Cochlear implant
  • Markup ratio
  • Mastoidectomy
  • Myringotomy
  • Regional variation
  • Stapedotomy/stapedectomy
  • Tympanomastoidectomy
  • Tympanoplasty


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