At Valhalla Business Advisors, we spend a lot of time digging into the numbers behind healthcare pricing, not because spreadsheets are inherently inspiring but because understanding how money actually moves through the system is the first step toward protecting employers and families from unnecessary costs.
Recently, we analyzed a high-cost subset of hospital services, including gene therapies, CAR-T treatments, and durable mechanical devices. These are the kinds of services where billed charges can stretch into the millions, and where very few employers ever get to see what’s really happening behind the scenes.
What we found wasn’t surprising, but the magnitude is always a reminder of how distorted the market has become.
In November 2025, Valhalla pulled data from Hershey Medical Center and, after scrubbing and sorting the data to emphasize the most costly services, these insights were developed. These data are not suggested as comprehensive or representative of all hospitals, or all the relevant criteria for considering whether to have care delivered at HMC; However, these data are directly drawn from HMC at this URL: DATA LINKED HERE.
Chargemaster vs. Reality: A World Apart
Hospitals maintain “chargemasters” — internal price lists that have little resemblance to market prices. For the items we analyzed:
- Cash-pay rates averaged ~35% of the chargemaster.
- Most commercial payers paid ~65–75% of the chargemaster.
- One major payer paid close to 93% of the chargemaster.
The chargemaster isn’t a price. It’s an anchor. And every other number in the system orbits around it.
This is one reason why two employers in the same market, for the same service, can see drastically different claims costs. The contract determines much of the economics.
Cash-Pay Isn’t the Floor (and Medicare Isn’t the Middle)
One of the more interesting findings was this:
Cash-pay was not the lowest price in the system. Medicare-like payers came in even lower — often near 20% of chargemaster.
This creates a strange dynamic where:
- This creates a strange dynamic where:
- Hospitals publicly post “discounted cash rates,”
- Commercial insurers pay double to triple those rates, and
- Government plans often pay far less than everyone else.
This is the reality employers are living within.
Payer Variation: Why It Matters for Employers
For employers, the key takeaway isn’t the absolute number — it’s the spread.
Across the same hospital, for the same drug or device:
- Commercial payer A may pay 2x the cash rate
- Commercial payer B may pay 2.6x the cash rate
- Commercial payer C may pay 1.6x the cash rate
That variation directly impacts:
- Stop-loss performance
- Renewal volatility
- Member out-of-pocket exposure
- Pricing of high-cost claimants
- Decisions around carve-outs, contract structures, and vendor selection
This is why data matters. It’s also why employers benefit from a fiduciary partner who is willing to challenge assumptions and ask hard questions.
Why We Do This Work
Analyses like this, even when they involve millions-dollar therapies and spreadsheets of reimbursement patterns, ultimately serve a human goal: creating a system that is fairer, more predictable, and more aligned with the people who fund it.
If you’d like to explore how this type of analysis applies to your plan, your claims experience, or your renewal strategy, our door is always open.
| description | code|1 | Charge Master | CASH PAY | Aetna Commercial | Aetna Signature Administrators Commercial | CBC CHIP | CBC Commercial | CBC Medicare | Cigna Commercial | First Health Commercial | Geisinger Commercial | Highmark Commercial | Preferred Healthcare Lancaster Commercial | UPMC Commercial |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Elevidys (10 - 10.4 kg) - 100 mL kit (JW) | 279571 | $8,351,171.31 | $2,930,426.01 | $5,849,160.39 | $6,001,986.82 | $4,729,727.63 | $5,710,530.94 | $1,586,722.55 | $5,570,231.26 | $6,263,378.48 | $6,376,954.41 | $12,097,798.32 | $6,263,378.48 | $6,263,378.48 |
| Zolgensma (10.1 - 10.5 kg) - 57.8 mL kit | 277646 | $5,909,827.67 | $2,073,758.53 | $4,139,243.3 | $4,247,393.15 | $3,347,060.45 | $4,041,140.16 | $1,122,867.26 | $3,941,855.06 | $4,432,370.75 | $4,512,744.41 | $8,124,680.29 | $4,432,370.75 | $4,432,370.75 |
| Q2042 ADULT CAR T-Cell Therapy (Tisagenlecleucel) | 8438781T | $2,513,666 | $882,045.4 | $1,381,914.76 | $1,423,790.96 | $1,423,627.31 | $1,718,844.81 | $477,596.54 | $1,058,385.72 | $1,885,249.5 | $1,919,435.36 | $1,728,442.59 | $1,885,249.5 | $1,885,249.5 |
| MCS TAH SYNCARDIA 50CC | 480264 | $830,431 | $291,398.24 | $581,633.87 | $596,830.76 | $470,318.75 | $567,848.72 | $157,781.89 | $553,897.48 | $622,823.25 | $634,117.11 | $622,823.25 | $622,823.25 | |
| MCS TAH KIT Snycardia | 480165 | $753,122 | $264,270.51 | $527,486.65 | $541,268.78 | $426,534.41 | $514,984.82 | $143,093.18 | $502,332.37 | $564,841.5 | $575,083.96 | $564,841.5 | $564,841.5 | |
| MCS Heartmate III Implant Kit | 480267 | $665,127 | $233,393.06 | $465,854.95 | $478,026.77 | $376,698 | $454,813.84 | $126,374.13 | $443,639.71 | $498,845.25 | $507,890.98 | $498,845.25 | $498,845.25 | |
| MCS Evaheart Implant Kit W/Belt | 481003 | $617,271 | $216,600.39 | $432,336.61 | $443,632.67 | $349,594.52 | $422,089.91 | $117,281.49 | $411,719.76 | $462,953.25 | $471,348.14 | $462,953.25 | $462,953.25 | |
| MCS HEART MATE II LVAD Implant | 480197 | $586,330 | $205,743.2 | $410,665.53 | $421,395.37 | $332,070.93 | $400,932.45 | $111,402.7 | $391,082.11 | $439,747.5 | $447,721.59 | $439,747.5 | $439,747.5 | |
| 38240 Marrow S/C Trnsplant Allo | 3540257 | $325,414 | $114,187.77 | $227,919.97 | $233,875.04 | $184,299.85 | $222,518.09 | $61,828.66 | $217,051.14 | $244,060.5 | $248,486.13 | $290,732.71 | $244,060.5 | $244,060.5 |
| 33276 Insrt Phrnc Nrv Stim System Tech | 9815341 | $281,253 | $98,691.68 | $196,989.6 | $202,136.53 | $159,289.04 | $192,320.8 | $53,438.07 | $187,595.75 | $210,939.75 | $214,764.79 | $251,017.38 | $210,939.75 | $210,939.75 |
| 33276 Insj Phrnc Nrv Stim Sys | 9811486T | $281,253 | $98,691.68 | $196,989.6 | $202,136.53 | $159,289.04 | $192,320.8 | $53,438.07 | $187,595.75 | $210,939.75 | $214,764.79 | $251,017.38 | $210,939.75 | $210,939.75 |
| 0266T ImpRplc BaroActSys Total Sys Tech | 7020730 | $281,253 | $98,691.68 | $196,989.6 | $202,136.53 | $159,289.04 | $192,320.8 | $53,438.07 | $187,595.75 | $210,939.75 | $214,764.79 | $251,017.38 | $210,939.75 | $210,939.75 |
| 0266T ImpRplc BaroActSys Total Sys | 8610973T | $281,253 | $98,691.68 | $196,989.6 | $202,136.53 | $159,289.04 | $192,320.8 | $53,438.07 | $187,595.75 | $210,939.75 | $214,764.79 | $251,017.38 | $210,939.75 | $210,939.75 |
| SPACER SPINAL TI 12D L L42MM W32MM H16MM MEDTRONIC INC 46521216 | 695844OR | $244,000 | $85,619.6 | $170,897.6 | $175,362.8 | $138,190.62 | $166,847.2 | $46,360 | $162,748 | $183,000 | $186,318.4 | $183,000 | $183,000 | |
| sipuleucel-T 250 mL bag inj. (JW) | 275516 | $233,814.81 | $82,045.62 | $163,763.89 | $168,042.7 | $132,422.19 | $159,882.57 | $44,424.81 | $110,030.46 | $175,361.11 | $178,540.99 | $190,714.65 | $175,361.11 | $175,361.11 |
| CCL IMPELLA PERC VAD 5.5 (LX) | 5172925 | $215,600 | $75,654.04 | $151,006.24 | $154,951.72 | $122,106.14 | $147,427.28 | $40,964 | $143,805.2 | $161,700 | $164,632.16 | $161,700 | $161,700 | |
| Impella Perc VAD 5.5 -> Yes | 5173610 | $215,600 | $75,654.04 | $151,006.24 | $154,951.72 | $122,106.14 | $147,427.28 | $40,964 | $143,805.2 | $161,700 | $164,632.16 | $161,700 | $161,700 | |
| STIMRUOUTER USER KIT BIONESS INC ST2-5050 | 691101OR | $210,636 | $73,912.17 | $147,529.45 | $151,384.09 | $119,294.75 | $144,032.9 | $40,020.84 | $140,494.21 | $157,977 | $160,841.65 | $157,977 | $157,977 | |
| SYSTEM FINAL PRODUCT ASSEMBLED MACI 1 MEMBRANE VERICEL CORP 81073 | 689207OR | $208,808 | $73,270.73 | $163,358.71 | $168,308.98 | $118,259.45 | $142,782.91 | $39,673.52 | $139,274.94 | $156,606 | $159,445.79 | $156,606 | $156,606 | |
| SH TRANSCATH VLVE DELIV SYSB (LX) | 3608009 | $201,021 | $70,538.27 | $140,795.11 | $144,473.79 | $113,849.25 | $137,458.16 | $38,193.99 | $134,081.01 | $150,765.75 | $153,499.64 | $150,765.75 | $150,765.75 | |
| 69930 Cochlear Dev Impl W/Wo Mastoid | 3541730 | $199,696 | $70,073.33 | $139,867.08 | $143,521.52 | $113,098.83 | $136,552.12 | $37,942.24 | $133,197.23 | $149,772 | $152,487.87 | $178,413.71 | $149,772 | $149,772 |
| SH TMVR SYSTEM (LX) | 3608048 | $199,570 | $70,029.11 | $139,778.83 | $143,430.96 | $113,027.47 | $136,465.97 | $37,918.3 | $133,113.19 | $149,677.5 | $152,391.65 | $149,677.5 | $149,677.5 | |
| 33231 Insrt Pulse Gen W/Mult Ld Tech | 3607883 | $195,912 | $68,745.52 | $137,216.76 | $140,801.95 | $110,955.74 | $133,964.63 | $37,223.28 | $130,673.3 | $146,934 | $149,598.4 | $175,033.04 | $146,934 | $146,934 |
| 33249 Ins/Rpl Icd Lead & Gen Tech | 3607867 | $195,912 | $68,745.52 | $137,216.76 | $140,801.95 | $110,955.74 | $133,964.63 | $37,223.28 | $130,673.3 | $146,934 | $149,598.4 | $175,033.04 | $146,934 | $146,934 |
| 33264 Remv&Replc Cvd Gen Multi Tech | 3607886 | $195,912 | $68,745.52 | $137,216.76 | $140,801.95 | $110,955.74 | $133,964.63 | $37,223.28 | $130,673.3 | $146,934 | $149,598.4 | $175,033.04 | $146,934 | $146,934 |
| 33270 Insert Subq Defib W/Eltrd Tech | 3607895 | $195,912 | $68,745.52 | $137,216.76 | $140,801.95 | $110,955.74 | $133,964.63 | $37,223.28 | $130,673.3 | $146,934 | $149,598.4 | $175,033.04 | $146,934 | $146,934 |
| 0408T Ins Rep Perm Card Plse Gen Tech | 5392957 | $195,912 | $68,745.52 | $137,216.76 | $140,801.95 | $110,955.74 | $133,964.63 | $37,223.28 | $130,673.3 | $146,934 | $149,598.4 | $175,033.04 | $146,934 | $146,934 |
| KIT RNS NEUROSTIMULATOR NEUROPACE RNS-320M-K | 668854OR | $195,836 | $68,718.85 | $137,163.53 | $140,747.33 | $110,912.7 | $133,912.66 | $37,208.84 | $130,622.61 | $146,877 | $149,540.37 | $146,877 | $146,877 | |
| histrelin 50 mg IMPLANT (JW) | 275233 | $192,738.42 | $67,631.91 | $120,921.82 | $124,586.12 | $109,158.37 | $131,794.53 | $36,620.3 | $90,700.44 | $144,553.82 | $147,175.06 | $159,408.1 | $144,553.82 | $144,553.82 |
| SH TRANSCATH AORTIC VALVE (LX) | 3608010 | $185,844 | $65,212.66 | $130,165.14 | $133,566.08 | $105,253.68 | $127,080.13 | $35,310.36 | $123,957.95 | $139,383 | $141,910.48 | $139,383 | $139,383 | |
| 33287 Rmv&Rplcmt Phrnc Nrv Stim Pg Tech | 9811498 | $184,914 | $64,886.32 | $129,513.77 | $132,897.69 | $104,726.97 | $126,444.19 | $35,133.66 | $123,337.64 | $138,685.5 | $141,200.33 | $165,207.02 | $138,685.5 | $138,685.5 |
| 33287 Rmv & Rplcmt Phrnc Nrv Stim Pg | 9815330T | $184,914 | $64,886.32 | $129,513.77 | $132,897.69 | $104,726.97 | $126,444.19 | $35,133.66 | $123,337.64 | $138,685.5 | $141,200.33 | $165,207.02 | $138,685.5 | $138,685.5 |
| 61886 Plcmt Neurostm Puls Gener, 2 Or More | 3541410 | $184,914 | $64,886.32 | $129,513.77 | $132,897.69 | $104,726.97 | $126,444.19 | $35,133.66 | $123,337.64 | $138,685.5 | $141,200.33 | $165,207.02 | $138,685.5 | $138,685.5 |
| 63685 Subcut Placement Nrostim Rcvr | 3541513 | $184,914 | $64,886.32 | $129,513.77 | $132,897.69 | $104,726.97 | $126,444.19 | $35,133.66 | $123,337.64 | $138,685.5 | $141,200.33 | $165,207.02 | $138,685.5 | $138,685.5 |
| 64568 Inc Implnt Cranial Nerve Neurostimulator Tech | 3607893 | $184,914 | $64,886.32 | $129,513.77 | $132,897.69 | $104,726.97 | $126,444.19 | $35,133.66 | $123,337.64 | $138,685.5 | $141,200.33 | $165,207.02 | $138,685.5 | $138,685.5 |
| 64582 Opn Imp Hpglsl Neurostim Array PG | 6514751T | $184,914 | $64,886.32 | $129,513.77 | $132,897.69 | $104,726.97 | $126,444.19 | $35,133.66 | $123,337.64 | $138,685.5 | $141,200.33 | $165,207.02 | $138,685.5 | $138,685.5 |
| 0268T ImpRplc BaroActSys Gen Only Tech | 7014803 | $184,914 | $64,886.32 | $129,513.77 | $132,897.69 | $104,726.97 | $126,444.19 | $35,133.66 | $123,337.64 | $138,685.5 | $141,200.33 | $165,207.02 | $138,685.5 | $138,685.5 |
| EP 0268T Gen Nrstm Barostim Neo2 IPG (LX) | 8212740 | $184,914 | $64,886.32 | $129,513.77 | $132,897.69 | $104,726.97 | $126,444.19 | $35,133.66 | $123,337.64 | $138,685.5 | $141,200.33 | $165,207.02 | $138,685.5 | $138,685.5 |
| 0268T ImpRplc BaroActSys Gen Only | 8665138T | $184,914 | $64,886.32 | $129,513.77 | $132,897.69 | $104,726.97 | $126,444.19 | $35,133.66 | $123,337.64 | $138,685.5 | $141,200.33 | $165,207.02 | $138,685.5 | $138,685.5 |
| 61889 Ins Sk-Mnt Crnl Nstm Pg/Rcvr | 9813473T | $176,151 | $61,811.39 | $123,376.16 | $126,599.72 | $99,764 | $120,452.05 | $33,468.69 | $117,492.72 | $132,113.25 | $134,508.9 | $216,002.43 | $132,113.25 | $132,113.25 |
| 33289 Transcath Impl Wrls Pulm Art Tech | 4475179 | $173,078 | $60,733.07 | $121,223.83 | $124,391.16 | $98,023.59 | $118,350.74 | $32,884.82 | $115,443.03 | $129,808.5 | $132,162.36 | $154,632.15 | $129,808.5 | $129,808.5 |
| 33289 Transcath Implant Wrls Pulm Art Prs Snr Tech | 4407237 | $173,078 | $60,733.07 | $121,223.83 | $124,391.16 | $98,023.59 | $118,350.74 | $32,884.82 | $115,443.03 | $129,808.5 | $132,162.36 | $154,632.15 | $129,808.5 | $129,808.5 |
| 0620T Evasc Ven Artlz Tibl/Prnl Vn Tech | 5290581 | $171,878 | $60,311.99 | $120,383.35 | $123,528.72 | $97,343.96 | $117,530.18 | $32,656.82 | $114,642.63 | $128,908.5 | $131,246.04 | $153,400.59 | $128,908.5 | $128,908.5 |
| 0620T Evasc Ven Artlz Tibl/Prnl Vn | 5290601T | $171,878 | $60,311.99 | $120,383.35 | $123,528.72 | $97,343.96 | $117,530.18 | $32,656.82 | $114,642.63 | $128,908.5 | $131,246.04 | $153,400.59 | $128,908.5 | $128,908.5 |
| 0620T Promise Evasc Ven Artlz Tibl/Prnl | 9881906T | $171,878 | $60,311.99 | $120,383.35 | $123,528.72 | $97,343.96 | $117,530.18 | $32,656.82 | $114,642.63 | $128,908.5 | $131,246.04 | $153,400.59 | $128,908.5 | $128,908.5 |
| MEMBRANE VERICEL CORP 69866-1030-01 | 678904OR | $170,580 | $59,856.52 | $163,358.71 | $168,308.98 | $96,608.84 | $116,642.6 | $32,410.2 | $113,776.86 | $127,935 | $130,254.89 | $127,935 | $127,935 | |
| CCL TRANSCATH PULMONARY VALVE (LX) | 3606535 | $169,555 | $59,496.85 | $118,756.32 | $121,859.18 | $96,028.32 | $115,941.71 | $32,215.45 | $113,093.19 | $127,166.25 | $129,472.2 | $127,166.25 | $127,166.25 |