Commercial Cardiology Prices Varied Widely Across US Insurers

Key Takeaways

• Using April 2025 Transparency in Coverage data reflecting 2023 contract-year claims, investigators analyzed negotiated prices for 32 common cardiology services across Blue Cross Blue Shield, UnitedHealthcare, Aetna, and Cigna Healthcare, insurers representing 78% of the commercial insurance market.
• Facility negotiated prices varied more than professional fees across cardiology services, with a median interquartile ratio of 2.56.
• Median facility prices for implantable cardioverter-defibrillator insertion ranged from $6,674 to $36,269 across payers.

Facility pricing for common cardiology services showed a broader spread than professional pricing, with a median interquartile ratio of 2.56 across services and median facility prices for implantable cardioverter-defibrillator insertion ranging from $6,674 to $36,269 across payers in a national analysis spanning 4 major insurers and 32 common services. In Philips and colleagues in JAMA Network Open, the findings provide a descriptive look at negotiated allowed amounts rather than clinical outcomes or quality.

In a cross-sectional analysis, investigators examined April 2025 Transparency in Coverage data reflecting 2023 contract-year claims. The dataset contained approximately 6.7 million professional price points and 104,563 facility price points, drawn from 51,568 physicians and 4,128 facilities nationwide for 32 common cardiology services across Blue Cross Blue Shield, UnitedHealthcare, Aetna, and Cigna Healthcare. Because those 4 insurers represent 78% of the commercial insurance market, the sample offered a broad view of negotiated cardiology prices, with comparisons made across insurers and across states. Overall, facility payments showed the wider spread.

In the investigators' description of commercial price variation across common cardiology services, geographic dispersion was evident for coronary angiography, for which the median facility price across states was $7,683 (IQR, $4,561-$10,101). The study also reported that Blue Cross Blue Shield had the highest mean facility prices and Aetna the lowest across most service categories. The researchers attributed insurer- and state-level differences to possible variation in contracting strategies and market dynamics, without linking the pricing patterns to differences in clinical performance. Overall, the clearest variation was in negotiated facility prices.

Clinician Questions

What data were used to compare commercial prices for common cardiology services across major US insurers?

The researchers conducted a cross-sectional analysis using April 2025 Transparency in Coverage data reflecting 2023 contract-year claims. The dataset covered 32 common cardiology services across Blue Cross Blue Shield, UnitedHealthcare, Aetna, and Cigna Healthcare, with approximately 6.7 million professional price points and 104,563 facility price points.

How wide was the payer variation in facility prices for implantable cardioverter-defibrillator insertion?

The researchers reported that median facility prices for implantable cardioverter-defibrillator insertion ranged from $6,674 to $36,269 across payers.

What state-level price variation was reported for coronary angiography?

The analysis reported a median facility price for coronary angiography across states of $7,683, with an interquartile range of $4,561 to $10,101. This describes geographic variation in negotiated facility prices for coronary angiography, not clinical outcomes.