Increasing healthcare costs in the United States (US) impose a growing burden for individuals and society [1]. Aggregating $3.8 trillion in 2019, US National Health spending is estimated to reach $6.2 trillion by 2028, according to the US Centers for Medicare & Medicaid Services [2]. This increase will exceed the estimated increase in gross domestic product by 1.1% each year [2]. Interregional price and cost differences for the same procedure, are believed to contribute to increasing National Health spending [1,3,4]. Interregional price and total hospital costs (THC) differences may exist regarding the same surgical procedure and may indicate a potential for expenditure savings. Surprisingly, only few historical studies have investigated and reported differences in total hospital costs (THC) for the same procedure in the fields of neurosurgery, orthopedics, trauma, gynecology and prostate cancer in the US [[5], [6], [7], [8], [9], [10]]. However, such differences have not been explored in the context of radical cystectomy for bladder cancer patients within a contemporary period [11,12]. In consequence we tested for interregional THC differences with specific attention to open (ORC) and robotic-assisted radical cystectomy (RARC). We hypothesized that presence of regional differences in historical reports has been addressed and resolved. To test this hypothesis, we relied on the National Inpatient Sample (NIS) database (2016–2019) [13].