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Background: No previous studies have studied the variation in costs between hospitals for catheterization procedures performed in children. Variation in cost not explained by differences in case-mix can indicate opportunities to improve efficiency and quality of care.Methods: A multicenter observational study was performed, studying total hospital costs of 9 common transcatheter procedures (diagnostic procedures in 2 populations and 7 interventional procedures) performed between 2007-2015 at hospitals contributing data to the Pediatric Health Information Systems database. Mixed effects models were used to adjust costs for case mix and to assess inter-hospital variation. Bayesian methods were used to calculate risk-standardized costs for each hospital.Results: The study included 35,637 procedures from 43 hospitals. Median costs (US 2015 dollars) increased roughly with technical complexity, from $8,249 (heart transplant diagnostic catheterization) to $38,909 (transcatheter pulmonary valve replacement). There was significant inter-hospital variation in cost for each procedure (p<0.0001). After case mix-adjustment, the range of standardized costs remained broad (Table). These differences were not explained by differences in hospital catheterization volume.Conclusion: There is significant inter-hospital variation in costs of transcatheter procedures after case-mix adjustment. Exploring the etiology of these differences is an opportunity to improve care of children with heart disease.