T2-A · Hospital already picked · UnitedHealthcare
Ray — his surgeon already booked the $21,335 hospital
Ray needs a hip replacement (CPT 27130). His surgeon picked UCHealth Grandview at $21,335. Pikes Peak Regional lists $10,878 for the same care. It is 16.4 straight-line miles from his ZIP code. This is not the road distance. The hospital price drops by $10,457, or 49%. Other parts of the bill may cost more.
- What happens
- Ray has already paid his deductible: the amount he pays before his plan shares costs. He now pays 30% of the bill, called coinsurance. His limit on what he pays has $8,000 left. With these demo rules, he pays $3,138 less and receives a $1,464 share. That is $4,602 in all. These are example plan rules, not a checked bill.
- Where the saving would come from
- This is an example, not a price quote. The hospital price drops by $10,457. Ray pays $3,138 less. That leaves $7,319 to split: $4,391 employer keeps, $1,464 to Ray, and $1,464 to DVRABLE. This works only if these prices and plan rules apply. It also assumes other bills stay the same.
- What we checked
- Both hospitals list the same United plan name: BROAD NETWORKS. Both use one set hospital price for a group of care codes: 170 CPTs and 16 HCPCS codes. These codes name care for billing. The price includes this hip code; it is not a price made just for this code. We have not checked which other bills it covers, such as the surgeon, sleep drugs, or hip parts. UCHealth owns both sites. Each site has its own price.
Check the listed hospital prices
UCHealth Grandview Hospital: $21,335.00 (listed insurance price).
UCHealth Pikes Peak Regional Hospital: $10,878.00 (listed insurance price).
These prices cover the hospital part of the bill. We still need to check other bills, plan coverage, and open dates.
T2-B · Lower published price nearby · BCBS
Dana — a lower price at another hospital
Dana needs a breast tissue test guided by an MRI scan (CPT 19085). Pikes Peak Regional lists $1,659. Memorial Central lists $845 for the same code. It is 19.1 straight-line miles from her ZIP code, not road miles. The hospital price drops by $814, or 49%.
- What happens
- Dana has already paid her deductible: the amount she pays before her plan shares costs. She now pays 30% of the bill, called coinsurance. Her limit on what she pays has $8,000 left. She pays $244 less and receives a $114 share. That is $358 in all. These are example plan rules, not a checked bill.
- Where the saving would come from
- This is an example, not a price quote. The hospital price drops by $814. Dana pays $244 less. That leaves $570 to split: $342 employer keeps, $114 to Dana, and $114 to DVRABLE. These prices and plan rules must apply. Other bills must stay the same.
- What we checked
- Both prices use Anthem HMO/PPO and the same care code. Both are listed hospital fees. UCHealth owns both sites. We still need to check other bills and what her plan covers.
Check the listed hospital prices
UCHealth Pikes Peak Regional Hospital: $1,658.98 (listed insurance price).
UCHealth Memorial Central: $845.04 (listed insurance price).
These prices cover the hospital part of the bill. We still need to check other bills, plan coverage, and open dates.