Variability in Commercial Pricing for Standard Cardiovascular Services Among Four Major US Insurance Providers

By
Alexander P. Philips
Sanket S. Dhruva
Christopher Whaley
July 16, 2026

Jama Network Open

Overview

This study examines the variability in commercial insurance payment rates for common cardiology services among four major US insurers. Findings reveal significant differences in pricing, particularly for facility fees compared to professional fees.

Background

Commercial insurance covers approximately half of the US population, yet the lack of transparency in negotiated rates leads to significant price variability. This variability complicates efforts by regulators and employers to negotiate better rates and ensure cost-effective care.

Data Highlights

The study analyzed TIC price data for 32 common cardiology services from four major insurers, revealing substantial price differences across services and insurers.

Key Findings

Facility pricing for cardiology procedures showed more variation than professional pricing across 25 of 26 services.
Diagnostic imaging and stress testing exhibited the most pronounced pricing differences.
The analysis included approximately 6.7 million unique price points for professional fees and 104,563 unique price points for facility fees.
Prices reflect negotiated amounts between insurers and providers, including patient cost-sharing.
The study utilized data from four major insurers, representing 78% of the commercial insurance market.

Clinical Implications

Clinicians should be aware of the significant price variability in cardiology services.

Conclusion

The findings highlight the variability in pricing for cardiology services among major insurers.

Variability in Commercial Pricing for Standard Cardiovascular Services Among Four Major US Insurance Providers