Commercial Price Variation for Common Cardiovascular Services Across 4 Major US Insurers

Importance: Cardiology services are among the most frequently used and costly services and procedures in US health care. Understanding price variation is essential for employers, patients, and policymakers to make informed decisions, contain costs, and promote value-based care. Objective: To assess the extent of variation in commercial insurance payment rates for common cardiology services across major US insurers and states using newly available Transparency in Coverage (TIC) data. Design, Setting, and Participants: This cross-sectional study used April 2025 TIC data from a third-party vendor reflecting 2023 contract year claims. The dataset included approximately 6.7 million professional and 104 563 facility price points for 32 common cardiology services across 4 major commercial insurers (Blue Cross Blue Shield, UnitedHealthcare, Aetna, and Cigna Healthcare), representing 78% of the commercial insurance market. The sample covered 51 568 physicians and 4128 facilities nationwide. Exposure: Negotiated allowed amounts paid by 4 major insurers for cardiology services, analyzed by Current Procedural Terminology code and grouped into categories such as diagnostic imaging, electrophysiology, and stress testing. Main Outcomes and Measures: Variation in allowed payment amounts for each cardiology service across insurers and states. Measures included median prices and IQRs, coefficients of variation, and volume-weighted price indices. Results: Facility negotiated price variation exceeded professional fee variation, with a median interquartile ratio of 2.56 across services. For example, median facility fees for implantable cardioverter-defibrillator (ICD) insertion ranged from $6674 (IQR, $3069-$11 402) to $36 269 (IQR, $18 673-$66 880) across insurers. Geographic variation was also substantial, with a median facility price for coronary angiography of $7683 (IQR, $4561-$10 101) across states. Blue Cross Blue Shield had the highest mean facility prices while Aetna had the lowest across most service categories. Conclusions and Relevance: In this cross-sectional study of commercial insurance payments for cardiology services, there was substantial variation across both insurers and states, particularly in facility fees. These findings reveal the influence of payer contracting strategies and market dynamics and underscore the need for greater transparency and regulatory oversight to promote efficient health care spending.