To examine variation in commercial insurance payment rates for common cardiology services using data reported by large commercial payers.
Approach:
Study Design: Cross-sectional study analyzing April 2025 TIC price data from four major insurers: Blue Cross Blue Shield, UnitedHealthcare, Cigna Healthcare, and Aetna.
Data Collection: Utilized TIC data for 32 common cardiology services, focusing on professional and facility fees, with analysis based on 6.7 million unique price points for physicians and 104,563 unique price points for facilities.
Statistical Analysis: Analyzed distributional differences in prices, coefficients of variation, and volume-weighted price indices by payer, with geographic variation examined for invasive coronary angiography.
Key Findings:
Facility pricing exhibited more variation than professional pricing across 25 of 26 services with facility charges.
Median facility fees for permanent pacemaker insertion ranged from $6,366 (IQR, $2,775-$10,714) for Aetna to $17,678 (IQR, $11,435-$30,304) for UnitedHealthcare.
Price variation in professional fees was notable but smaller, with median professional fees for permanent pacemaker insertion ranging from $344 for Aetna to $885 for UnitedHealthcare.
Aetna's facility prices were the lowest, while Blue Cross Blue Shield consistently had the highest facility prices for cardiology services.
Interpretation:
Limitations:
The study is limited to data from four major insurers, which may not represent the entire commercial insurance market.
The analysis is based on negotiated rates and does not include cash prices or chargemaster rates.
Conclusion:
The findings reveal substantial price variation in cardiology services.
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