Devika A. Shenoy, William C. Cruz, Shamik Bhat, Katelyn Parsons, Aaron D. Therien, Kevin A. Wu, Christian A. Pean, William C. Eward
Abstract
Radical resection of bone tumors is a clinically effective but costly procedure. Despite the implementation of federal price transparency mandates, little is known about the nationwide variation in negotiated prices for these specialized oncologic surgeries.
Introduction
The management of primary and metastatic bone tumors has evolved greatly over the past few decades, with new options for advanced surgical reconstructions and targeted immunotherapy providing patients with multifaceted treatment options. [1–4] While primary bone cancers account for only 0.2% of primary malignancies in the United States (U.S.), approximately 5.1% of patients with other malignancies report developing bone metastases.
Materials and methods
This is a cross-sectional study evaluating negotiated prices between hospitals and payors from the Turquoise Health (TQH) “Clear Rates” Database, which aggregates U.S. hospital-reported negotiated payor rates for common procedures by current procedural terminology (CPT) code. [21]
Results
A total of 285,857 negotiated payor rates were included for analysis (Table 1). This comprised 177,728 rates for radical resection of the humerus (CPT 24150) and 108,129 rates for radical resection of the femur/knee (CPT 27365).
Discussion
To our knowledge, this is the first study to leverage a national price transparency database to investigate the negotiated payor rates for radical resection of bone tumors. Our analysis of over 285,000 negotiated rates for radical resection procedures of the humerus and femur/knee reveals significant price variation driven by hospital, payor, regional, and state-level policy factors.
Conclusions
In conclusion, the price of radical bone tumor resection in the U.S. shows significant, often counterintuitive variability and may be driven in part by market dynamics. These findings underscore the urgent need for more granular data to understand these price drivers, which is essential for developing a more rational, predictable, and equitable pricing system for vital cancer care.
Citation: Shenoy DA, Cruz WC, Bhat S, Parsons K, Therien AD, Wu KA, et al. (2026) Exploring the drivers of price variation in orthopaedic radical bone tumor resection: A nationwide database study. PLoS One 21(2): e0343676. https://doi.org/10.1371/journal.pone.0343676
Editor: Xiaoen Wei, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, CHINA
Received: August 27, 2025; Accepted: February 6, 2026; Published: February 26, 2026
Copyright: © 2026 Shenoy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Payor information obtained from Turquoise Health: https://turquoise.health. Medicaid and regulatory information extracted from Kaiser Family Foundation and National Conference of State Legislatures: https://www.kff.org/affordable-care-act/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D, https://www.ncsl.org/health/certificate-of-need-state-laws NP independent practice regulatory data from American Association of Nurse Practitioners Data: https://www.aanp.org/advocacy/state/state-practice-environment All-Payer Claims Database data from University of New Hampshire and National Association of Health Data Organizations: https://www.apcdcouncil.org/state-efforts/apcd-legislation-state Additional data availability information: 1. Negotiated rate (primary outcome), payor type, total bed range of hospital, hospital type, hospital location: Obtained from the Turquoise Health “Clear Rates” database under a licensing agreement. Further information can be found at https://turquoise.health/products/clear_rates_data. Researchers interested in working with this dataset can contact Turquoise Health via https://turquoise.health/contact?page=contact-us. 2. Medicaid expansion status: obtained from a publicly-available source via the Kaiser Family on December 31st, 2024: https://www.kff.org/affordable-care-act/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D 3. Certificate of Need status: Data was obtained from a publicly-available source via the National Conference of State Legislatures on December 31st, 2024: https://www.ncsl.org/health/certificate-of-need-state-laws 4. NP scope-of-practice regulatory laws: Data was obtained from a publicly-available source via the American Association of Nurse Practitioners on July 1st, 2025: https://www.aanp.org/advocacy/state/state-practice-environment 5. All-Payer Claims Database (APCD) state participation: Data was obtained from a publicly-available source via the University of New Hampshire and National Association of Health Data Organizations on July 1st, 2025: https://www.apcdcouncil.org/state-efforts/apcd-legislation-state 6. U.S. Census Bureau Region: Data was obtained from a publicly-available source via the U.S. Census Bureau at https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Abbreviations: CPT, Current Procedural Terminology; CoN, Certificate of Need; APCD, All-Payer Claims Database; NP, Nurse Practitioner; CMS, Centers for Medicare & Medicaid Services; TQH, Turquoise Health; VA, Veteran Affairs; CAH, Critical Access Hospitals; SD, Standard Deviation; IQR, Interquartile Range.
