The price of a cardiology procedure can depend less on the complexity of the care and more on which insurer is footing the bill, according to new price transparency data. The analysis, published in JAMA Network Open, drew on April 2025 Transparency in Coverage filings from Blue Cross Blue Shield, UnitedHealthcare, Aetna and Cigna — a group that together covers 78% of the U.S. commercial insurance market.
Researchers examined roughly 6.7 million professional and 104,000 facility price points across 32 common cardiology services, covering 51,000 physicians and 4,000 facilities. They grouped procedures into diagnostic imaging, electrophysiology, interventional cardiology and stress testing, then compared negotiated allowed amounts by CPT code across payers and states.
The gap wasn’t in physician pay. Facility fees varied far more than professional fees overall, with an interquartile ratio of 2.56 compared to 1.78. The disparity was most pronounced in imaging: transthoracic echocardiogram facility fees swung by a ratio of 3.87 across payers, versus just 0.61 for professional fees.
Median facility fees for ICD placement ranged from $6,600 with Aetna to $36,000 with UnitedHealthcare. Pacemaker insertion showed a similar spread, from $6,300 to $17,600. Professional fees for the same procedures barely moved — ICD placement professional fees spanned only $610 to $1,500 across all four payers.
Each insurer displayed a distinct pricing pattern that researchers attributed to differing negotiation strategies. Blue Cross Blue Shield consistently paid the highest facility prices, up to 1.31 times the market average, while Aetna paid the lowest across nearly all services — as little as 0.39 times the market average, even for complex electrophysiology procedures. Geography added another layer of unpredictability: the median facility price for intracoronary angiography with catheterization was $7,600, but ranged from $4,500 to $10,000 depending on the state.
None of that variation tracked with quality. Prior research has found no relationship between higher prices and better care outcomes or efficiency, meaning patients paying the most for cardiology care aren’t necessarily getting more for it. With most Americans insured by a small group of dominant payers, the researchers found little built-in pressure for those costs to come down.
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