Testosterone testing in the United States: limited price transparency and significant variability

In response to the 2021 Hospital Price Transparency Regulation by The Centers for Medicare & Medicaid Services (CMS), we evaluated hospital-reported price transparency and variability for testosterone (T) testing across the United States (US). Using the Turquoise database, hospitals disclosing free or total T test prices were identified. Hospital characteristics were compared between price reporters and non-reporters. Multivariable regression identified reporting predictors and assessed price variability by test and payer type. Of 6700 hospitals, 51.7% reported at least one T test price. Reporting was more common among larger hospitals (median 100 vs. 75 beds, p < 0.001), non-profits (62.7 vs. 44.3%, p < 0.001), and those with higher compliance scores (4.5 vs. 3, p < 0.001). Regional variation was significant (p < 0.001), but no urban-rural differences were observed (p = 0.71). Median prices were $84.90 (Interquartile range $44.0, $138.0) for total T and $92.27 ($49.17, $144.35) for free T, varying by payer: $79.43 ($40.82, $131.32) for commercial insurance and $98.00 ($54.65, $148.84) for self-pay. On multivariable analysis, hospitals in competitive markets and with more beds tended to have lower prices, while hospital ownership did not significantly affect pricing. Despite the legislation, nearly half of hospitals fail to report prices, driving significant price variation and limiting informed consumer choices.