Payer type drives wide variation in glaucoma surgery prices | AAO 2026

Hospital list prices and payer-negotiated rates for glaucoma surgery vary widely across the United States, and payer class showed the most consistent association with price, according to data presented at the annual meeting of the American Academy of Ophthalmology (AAO) being held Oct. 9 through Oct. 12, 2026, in New Orleans.

The session, ‘List Price and Payer Rate Variation of Glaucoma Surgery in the United States,' was presented by co-author Ahmad Kunbaz, M.D., a postdoctoral research fellow at the University of Illinois Chicago, Department of Ophthalmology & Visual Sciences. Kunbaz and his team also found that safety-net hospitals and hospitals in highly concentrated markets had lower adjusted prices for most of the procedures studied, a result he described as the “most surprising of the analysis.”

Federal price transparency rules in effect since 2021 require hospitals to post their standard charges, including chargemaster list prices and the rates they negotiate with individual payers. The researchers used those disclosures to examine how prices for 11 glaucoma surgery procedure codes vary by payer, hospital characteristics, market concentration and state policy. More than 4 million U.S. adults have glaucoma, according to an estimate from the Centers for Disease Control and Prevention.

How the dataset was built

Kunbaz and his team extracted facility fee data from a national hospital price transparency database, Turquoise Health, and linked each price to hospital, market and state-level variables, including CMS star ratings, data from the Health Care Cost Institute, Medicaid expansion status, certificate-of-need laws and census region.

The final dataset included 41,420 list prices and payer rates from 144 hospitals, and 25,315 rates were included in the fully adjusted models. Commercial insurance served as the reference group for comparisons with list prices, Medicare Advantage, Medicaid and self-pay rates for uninsured patients. Researchers analyzed the data using generalized linear models with a gamma distribution.

Payer class showed the most consistent pattern

Median list prices ranged from $2,092 to $10,014 across the 11 procedures, and list prices were generally the highest of any price category. In adjusted models, Medicaid and self-pay rates were significantly lower than commercial rates for all 11 procedures, with commercial rates running 1.59 to 2.10 times Medicaid rates and Medicare Advantage rates were lower for 10 of 11. List prices were higher than commercial rates for every procedure and significantly higher for five.

Commercial rates initially appeared to exceed list prices for six procedures, but researchers said that reflected differences in which hospitals reported each figure. When they compared the same procedure within the same hospital, median commercial rates fell below list prices, and the difference was statistically significant for nine of the 11 procedures.

Hospital type also mattered. Community hospitals had lower rates than academic medical centers for five of the 11 procedures, with relative risks (RR) ranging from 0.39 to 0.76. Safety-net hospitals had lower rates for seven of the 11 procedures (RR 0.42 to 0.85), and hospitals in highly concentrated markets had lower rates for nine of 11. CMS star ratings showed no consistent direction. Prices were higher in Medicaid expansion states for four procedures and in states with certificate-of-need laws for five. Results varied across census regions compared with New England, the reference region.

Kunbaz said the lower prices in concentrated markets could reflect teaching hospital status and differences in negotiating leverage with insurers, though those explanations were not directly tested. During the question-and-answer session, Kunbaz noted that prices might be expected to rise where only two or three providers serve a market and suggested that high patient volumes may give these hospitals more room to negotiate with insurance companies.

“These findings support clear patient-facing price information and financially sustainable providers,” Kunbaz concluded. “All hospitals should provide this data because we need to give the patient the best care we can with the transparency of the different prices for these surgeries.”