Parkview Healthplan Services: disclosed hospital rates

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Based on the published hospital price files, Parkview Healthplan Services appears in disclosed negotiated rates across 1 hospital and 72 services. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

72 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
00003-2328-22 - ipilimumab Soln Outpatient	Lutheran Downtown Hospital	1279402-2255213 CDM	$494,190	$118,606	$118,606 – $494,190	—
00008-0100-01 - inotuzumab ozogamicin 0.9 mg Powde Outpatient	Lutheran Downtown Hospital	108819334-2247357 CDM	$236,032	$56,648	$56,648 – $236,032	—
00078-0734-61 - canakinumab 150 mg/mL Soln Outpatient	Lutheran Downtown Hospital	109124434-2255213 CDM	$263,123	$63,149	$63,149 – $263,123	—
00169-7208-01 - coagulation factor VIIa 8000 mcg ( Outpatient	Lutheran Downtown Hospital	95380079-2247360 CDM	$249,311	$59,835	$17,112 – $249,311	—
00310-4535-30 - tremelimumab actl 20 mg/mL Soln Outpatient	Lutheran Downtown Hospital	109228707-2247357 CDM	$413,990	$99,358	$99,358 – $413,990	—
25682-0028-01 - ravulizumab 100 mg/mL Soln Outpatient	Lutheran Downtown Hospital	108326359-2255213 CDM	$340,479	$81,715	$81,715 – $340,479	—
30237-8900-06 - sipuleucel-T - Susp Outpatient	Lutheran Downtown Hospital	51905029-2247357 CDM	$752,774	$180,666	$180,666 – $752,774	—
4060018 OTH STER SUPP LVL 18[Omnicell Cath Lab] Outpatient	Lutheran Downtown Hospital	100133675-2114382 CDM	$269,188	$64,605	$64,605 – $269,188	—
4064907 TAVR L2[Omnicell Cath Lab] Outpatient	Lutheran Downtown Hospital	C1763 HCPCS	$232,300	$55,752	$17,112 – $232,300	—
4070018 OTH STER SUPP LVL 18[Omnicell EP Lab] Outpatient	Lutheran Downtown Hospital	103179668-2114382 CDM	$269,188	$64,605	$64,605 – $269,188	—
4690018 OTH STER SUPP LVL 18[Omnicell IR] Outpatient	Lutheran Downtown Hospital	103179900-2114382 CDM	$253,951	$60,948	$60,948 – $253,951	—
50242-0150-01 - ocrelizumab 300 mg/10 mL Soln Outpatient	Lutheran Downtown Hospital	J2350 HCPCS	$285,458	$68,510	$70.18 – $285,458	—
54396-0801-01 - pegloticase Soln Outpatient	Lutheran Downtown Hospital	1286149-2255213 CDM	$404,861	$97,167	$97,167 – $404,861	—
54482-0301-01 - pegaspargase 3750. Soln Outpatient	Lutheran Downtown Hospital	1282362-2255213 CDM	$370,304	$88,873	$88,873 – $370,304	—
57665-0002-02 - pegaspargase 3750. Soln Outpatient	Lutheran Downtown Hospital	1282361-2255213 CDM	$370,304	$88,873	$88,873 – $370,304	—
57894-0061-03 - ustekinumab 90 mg/mL Soln Outpatient	Lutheran Downtown Hospital	94990000-2255213 CDM	$358,159	$85,958	$85,958 – $358,159	—
60809-0801-01 - pegloticase 8 mg/mL Soln Outpatient	Lutheran Downtown Hospital	95367892-2255213 CDM	$404,861	$97,167	$97,167 – $404,861	—
67979-0002-01 - histrelin 50 mg Implan Outpatient	Lutheran Downtown Hospital	108087544-2247355 CDM	$431,276	$103,506	$103,506 – $431,276	—
69866-1025-01 - autologous cultured chondrocytes 0 Outpatient	Lutheran Downtown Hospital	108963946-2247355 CDM	$415,834	$99,800	$17,112 – $415,834	—
69866-1030-05 - autologous cultured chondrocytes i Outpatient	Lutheran Downtown Hospital	108963947-2247355 CDM	$415,834	$99,800	$99,800 – $415,834	—
69866-1030-08 - autologous cultured chondrocytes 1 Outpatient	Lutheran Downtown Hospital	108978003-2247355 CDM	$415,834	$99,800	$99,800 – $415,834	—
71336-1001-01 - givosiran 189 mg/mL Soln Outpatient	Lutheran Downtown Hospital	108329173-2255213 CDM	$565,500	$135,720	$135,720 – $565,500	—
72187-0401-01 - tagraxofusp 1000 mcg/mL Soln Outpatient	Lutheran Downtown Hospital	108290516-2247357 CDM	$328,602	$78,864	$78,864 – $328,602	—
72493-0103-03 - mitoMYcin 40 mg Kit Outpatient	Lutheran Downtown Hospital	108503656-2247357 CDM	$251,612	$60,387	$60,387 – $251,612	—
72694-0954-01 - pegaspargase 3,750 IntlUnit(s) / 5 Outpatient	Lutheran Downtown Hospital	108107889-2255213 CDM	$370,304	$88,873	$17,112 – $370,304	—