New price transparency data reveals how wildly insurance payments, reimbursements, and facility fees for cardiology swing across insurers and states, which underscores the complexity of U.S. healthcare costs.
- The analysis used “April 2025 Transparency in Coverage” data from America’s four largest commercial insurers: Blue Cross Blue Shield, UnitedHealthcare, Aetna, and Cigna (78% of the commercial market).
- This provided insights into roughly 6.7M professional and 104k facility price points across 32 common cardiology services, covering 51k physicians and 4k facilities.
Researchers analyzed the negotiated allowed amounts by CPT code, grouping services into diagnostic imaging, electrophysiology, interventional cardiology, and stress testing, then compared prices across payors and states.
- Facility price variation far exceeded professional fee variation (IQR: 2.56 vs. 1.78).
- That gap was starkest within imaging, with transthoracic echocardiogram facility fees seeing a 3.87 variation ratio compared to just 0.61 for the professional fee.
But beyond variability, the dollar figures on device procedures are eye-popping.
- Median facility fees for ICD placement ranged from $6.6k with Aetna to $36k with UnitedHealthcare (quite the spread).
- Pacemaker insertion showed a similar pattern, from $6.3k with Aetna to $17.6k with UnitedHealthcare.
- By contrast, these procedures’ professional fees varied far less — ICD placement professional fees spanned only $610 to $1.5k across payors.
Each insurer showed a distinct pricing personality, which the authors attribute to differing negotiation strategies.
- For reference, BCBS consistently had the highest facility prices, up to 1.31x the market average.
- Meanwhile, Aetna had the lowest across nearly all services, as little as 0.39 times the market average even for complex procedures like electrophysiology.
Geography further compounds the problem, because where a patient lives can matter as much as who insures them.
- In the case of ICA with catheterization, the median facility price was $7.6k, but it could be anywhere between $4.5k to $10k depending on the state.
The kicker to all this? Prior research has already confirmed there’s no relationship between higher prices and better care quality or efficiency, so the patients paying more aren’t necessarily getting more.
The Takeaway
This analysis opens our eyes to just how arbitrary the cost of cardiology is across the country, and with most American patients insured by an oligopoly of four payors, there’s little reason for those costs to come down. At least we know it’s not the cardiologists’ fault.
