Cardiology Prices Vary Widely by Insurer and State

Commercial insurance payments for common cardiology services, from stress tests to defibrillator implantation, vary dramatically depending on the insurer and geographic market, according to a cross-sectional study published in JAMA Network Open.¹

“We found substantial variation in commercial pricing for common cardiology procedures, with greater variability in facility than professional prices,” wrote the researchers of the study. “These findings build on prior analyses by capturing not only geographic but also payer-specific differences, underscoring the influence of unique negotiation strategies among insurers.”

Using April 2025 Transparency in Coverage (TIC) files containing negotiated commercial rates from 2023 contracts, researchers analyzed roughly 6.7 million professional and more than 104,000 facility price points for 32 common cardiology services across 4 major national insurers—Blue Cross Blue Shield (BCBS), UnitedHealthcare, Aetna, and Cigna Healthcare—which together account for 78% of the US commercial insurance market. The sample spanned 51,568 physicians and 4128 facilities nationwide.

Facility Fees Show the Widest Swings

Facility price variation outpaced professional fee variation for 25 of 26 services with a facility charge, with the gap most pronounced in diagnostic imaging and stress testing. Median (IQR) facility fees for implantable cardioverter-defibrillator (ICD) insertion ranged from $6674 ($3069-$11,402) for Aetna to $36,269 ($18,673-$66,880) for UnitedHealthcare—more than a 5-fold difference for a single procedure. Permanent pacemaker insertion showed a similar pattern, with median facility fees spanning $6366 (Aetna) to $17,678 (UnitedHealthcare).

Professional fees varied less but were still substantial: median professional fees for ICD placement ranged from $610 (Aetna) to $1581 (UnitedHealthcare). Across payers, the median IQR for facility prices was 2.56 compared with 1.78 for professional fees.

Geographic and Payer Variation

Geographic variation further contributed to pricing differences. For invasive coronary angiography with left heart catheterization, the median facility price across states was $7683 ($4561-$10,101) even after accounting for insurer differences. Wisconsin, Alaska, and Wyoming had among the highest median negotiated prices, differences the study authors suggest could reflect provider market concentration, bargaining power, or characteristics of rural health care markets.

Volume-weighted price indices showed BCBS generally had the highest facility price indices across service categories, while Aetna’s facility prices were lowest—as little as 39% of the 4-insurer average for cardiac electrophysiology procedures. UnitedHealthcare’s facility index for stress testing peaked at 1.46, and Cigna’s interventional cardiology facility index reached 1.30.

Limited Correlation With Quality

The study’s authors acknowledged several limitations, including an inability to stratify prices by site of service—a factor increasingly recognized as a driver of facility price variation as care shifts from lower-cost office settings to hospital outpatient departments. The analysis also included only 4 national commercial insurers and did not capture Medicare, Medicaid, or uninsured populations. Prior research cited by the authors has found little association between negotiated prices and quality of care, suggesting the observed variation is more likely related to contracting leverage and market consolidation than differences in clinical outcomes.

The findings align with other analyses of TIC data documenting similarly wide, largely unexplained price variation beyond cardiology. A separate 2025 analysis by Trilliant Health of TIC data from more than 2600 hospitals and 3400 ambulatory surgical centers found that negotiated rates for inpatient procedures varied by an average ratio of 9.1 nationally, with no observable correlation between hospital quality measures and negotiated prices.²

Managed Care Implications

For managed care stakeholders, the findings reinforce the case for using TIC data proactively rather than reactively. Payers and self-insured employers can benchmark facility contracts against national indices to identify potential overpayment risk, particularly in electrophysiology and diagnostic imaging, where variation was greatest. Health systems negotiating with multiple payers may also better understand how their negotiated rates compare with market benchmarks. For policymakers, the persistence of substantial price variation, even after 2 years of TIC implementation, suggests current transparency requirements alone may be insufficient to improve market efficiency, strengthening the case for standardized reporting formats and more consistent enforcement of data completeness requirements.

Overall, the analysis suggests that differences in facility contracting, not physician reimbursement, account for much of the commercial price variation observed across common cardiovascular services.¹

“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,” wrote the researchers. “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.”

References

1. Philips AP, Dhruva SS, Whaley C. Commercial price variation for common cardiovascular services across 4 major US insurers. JAMA Netw Open. 2026;9(7):e2623326. doi:10.1001/jamanetworkopen.2026.23326
2. Oakes A. Leveraging transparency in coverage data to reveal actionable information on commercial rates. Trilliant Health. 2025. Accessed July 15, 2026. https://www.trillianthealth.com/market-research/reports/2025-price-transparency