Prime Health Services: disclosed hospital rates

iDirect answer

Based on the published hospital price files, Prime Health Services appears in disclosed negotiated rates across 2 hospitals and 226 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.

226 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
00003-2328-22 - ipilimumab Soln Inpatient	Lutheran Downtown Hospital	1279402-2255213 CDM	$494,190	$271,805	$140,844 – $494,190	—
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 Inpatient	Lutheran Downtown Hospital	108819334-2247357 CDM	$236,032	$129,818	$67,269 – $236,032	—
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 Inpatient	Lutheran Downtown Hospital	109124434-2255213 CDM	$263,123	$144,717	$74,990 – $263,123	—
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 ( Inpatient	Lutheran Downtown Hospital	95380079-2247360 CDM	$249,311	$137,121	$71,054 – $249,311	—
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 Inpatient	Lutheran Downtown Hospital	109228707-2247357 CDM	$413,990	$227,694	$117,987 – $413,990	—
00310-4535-30 - tremelimumab actl 20 mg/mL Soln Outpatient	Lutheran Downtown Hospital	109228707-2247357 CDM	$413,990	$99,358	$99,358 – $413,990	—
10-0 ETHILON BLACK 1X5 V75-3 Inpatient	University of Illinois Hospital and Clinics (UI Health)	A4649 HCPCS	$105	$73.79	$34.79 – $2,385	—
10-0 ETHILON BLACK 1X5 V75-3 Outpatient	University of Illinois Hospital and Clinics (UI Health)	A4649 HCPCS	$105	$73.79	$34.79 – $2,385	—
25682-0028-01 - ravulizumab 100 mg/mL Soln Inpatient	Lutheran Downtown Hospital	108326359-2255213 CDM	$340,479	$187,264	$97,037 – $340,479	—
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 Inpatient	Lutheran Downtown Hospital	51905029-2247357 CDM	$752,774	$414,026	$214,541 – $752,774	—
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] Inpatient	Lutheran Downtown Hospital	100133675-2114382 CDM	$269,188	$148,053	$76,719 – $269,188	—
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] Inpatient	Lutheran Downtown Hospital	C1763 HCPCS	$232,300	$127,765	$54,800 – $232,300	—
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] Inpatient	Lutheran Downtown Hospital	103179668-2114382 CDM	$269,188	$148,053	$76,719 – $269,188	—
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] Inpatient	Lutheran Downtown Hospital	103179900-2114382 CDM	$253,951	$139,673	$72,376 – $253,951	—
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 Inpatient	Lutheran Downtown Hospital	J2350 HCPCS	$285,458	$157,002	$81,356 – $285,458	—