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

Area of Science:

• Health Economics
• Health Services Research
• Cardiology

Background:

• Cardiology services represent a significant portion of US healthcare expenditure.
• Understanding price variation is crucial for informed decision-making by employers, patients, and policymakers.
• Controlling costs and promoting value-based care necessitate insights into pricing dynamics.

Purpose of the Study:

• To quantify the variation in commercial insurance payment rates for common cardiology services.
• To analyze these payment rate variations across major US insurers and states.
• To leverage newly available Transparency in Coverage (TIC) data for this assessment.

Main Methods:

• A cross-sectional study utilizing April 2025 TIC data (reflecting 2023 claims).
• Inclusion of approximately 6.7 million professional and 104,563 facility price points for 32 cardiology services.
• Analysis across four major commercial insurers (BCBS, UHC, Aetna, Cigna) and nationwide physician/facility data.

Main Results:

• Substantial variation observed in allowed payment amounts for cardiology services across insurers and states.
• Facility negotiated price variation was notably higher than professional fee variation (median IQR of 2.56).
• Significant geographic price disparities were found, with examples like implantable cardioverter-defibrillator insertion and coronary angiography.

Conclusions:

• Commercial insurance payments for cardiology services exhibit considerable variation, particularly in facility fees.
• Payer contracting strategies and market dynamics significantly influence these price differences.
• Enhanced transparency and regulatory oversight are essential for promoting efficient healthcare spending.