We examine the relationship between physician preferences and both the intensity and cost of care delivered to commercially insured heart attack patients. We find that the survey-based preference measures collected by Cutler et al. (2019) (CSSW) predict variations in utilization that are same-signed, though substantially muted, relative to the strong relationships CSSW uncovered for both treatment and expenditure for Medicare beneficiaries. Additionally, regions with aggressive practice styles receive sufficiently lower reimbursements from commercial insurers that variations in practice preferences have weak correlations with expenditures in the commercial market. We present a parsimonious model of commercial insurers’ pricing that can rationalize this fact pattern.