© 2017 Elsevier Inc. Background Parathyroidectomy is the only curative therapy for hyperparathyroidism, but its cost and variation in use among different racial and ethnic groups are largely unexamined. The purpose of this study was to examine the association between race and ethnicity and the total hospital cost of parathyroidectomy. Methods This retrospective study included 899 consecutive complete parathyroidectomies in our institution between September 2011 and July 2016. Total length of stay and cost were primary outcomes. Nonparametric and chi-square tests were used for analysis. Results The study population was 66.4% Caucasian, 31.4% African American, 0.7% Hispanic, and 0.3% Asian. Total hospital costs were greater for African-American patients ($6154.87 ± 389.18) compared to Caucasian patients ($5253.28 ± $91.74). Mean length of stay was 0.99 ± 0.18 for African-American patients and 0.44 ± 0.05 for Caucasian patients. African-American patients were more likely than Caucasian patients to be readmitted (4.6% versus 1.2%). Among African Americans, males had a more expensive hospital cost, higher incidence of cases that cost greater than $10,000, and longer length of stay compared to females. Conclusions African-American race was associated with higher hospital costs for parathyroidectomy compared to Caucasian patients, especially male patients. The increased cost could be explained in part by longer length of stay. More detailed efforts are needed to reduce racial disparity in the management of parathyroidectomy patients.