Commercial price variation for common imaging studies.

INTRODUCTION

Commercial insurance payment rates for imaging studies have significant price variation, yet understanding this variation has been limited by lack of transparency and data limitations.

METHODS

Using newly available Transparency-in-Coverage insurer-posted data on negotiated rates, we analyzed price variation for the 2023 contract year across four major commercial insurers (Blue Cross Blue Shield, United, Cigna, and Aetna) for 30 imaging studies. Our analysis encompassed 12.7 million professional fee price points and 239 969 facility fee price points.

RESULTS

Our analysis revealed substantial variation in reimbursement rates. Key findings include greater variation in facility fees compared to professional fees, with facility coefficients of variation often 3 to 6 times higher than professional components. There was also substantial and inconsistent variation by payer. Geographic analysis revealed significant state-level variation, particularly in facility fees.

CONCLUSION

These findings highlight the complex interplay of market dynamics and negotiating strategies in determining healthcare prices, with implications for policymakers, purchasers, and clinicians guiding patient care decisions.