Advocate Good Samaritan Hospital
3815 Highland Avenue, Downers Grove, IL · Advocate Health · · NPI 1578670543
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Tc-99m exame autol wbc diag per dose HCPCS A9569 | $1,314.50 | $2,629.00 | $1,035.83 – $6,037.39 | 17 |
| Tc-99m exametazime diag HCPCS A9521 | not published | not published | $1,163.39 – $5,398.30 | 13 |
| Tc-99m graphite crucible HCPCS A9506 | not published | not published | $476.47 – $1,110.67 | 8 |
| Tc-99m labeled rbc HCPCS A9560 | not published | not published | $169.17 – $346.55 | 6 |
| Tc-99m maa HCPCS A9540 | $150.00 | $300.00 | $53.82 – $240.00 | 13 |
| Tc-99m mebrofenin HCPCS A9537 | not published | not published | $112.84 – $383.49 | 6 |
| Tc-99m medronate HCPCS A9503 | not published | not published | $26.52 – $267.96 | 9 |
| Tc-99m mertiatide HCPCS A9562 | not published | not published | $1,304.46 – $2,672.16 | 4 |
| Tc-99m non-heu per study dose HCPCS Q9969 | $5.00 | $10.00 | $3.94 – $33.80 | 17 |
| Tc-99m oxidronate HCPCS A9561 | not published | not published | $85.68 – $175.52 | 6 |
| Tc-99m pentetate dtpa HCPCS A9539 | not published | not published | $49.98 – $102.38 | 6 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | not published | not published | $34.60 – $70.88 | 6 |
| Tc-99m pertechnetate per mci HCPCS A9512 | not published | not published | $3.40 – $25.89 | 6 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | not published | not published | $74.15 – $151.90 | 6 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $257.50 | $515.00 | $189.82 – $1,522.96 | 13 |
| Tc-99m succimer (dmsa) HCPCS A9551 | not published | not published | $1,153.96 – $2,363.87 | 6 |
| Tc-99m sulfur colloid HCPCS A9541 | not published | not published | $545.42 – $1,327.63 | 6 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | not published | not published | $173.96 – $1,410.27 | 9 |
| Tc-99m tilmanocept diag HCPCS A9520 | $320.00 | $640.00 | $9.38 – $1,349.62 | 13 |
| Tca peel dermal 15789 CPT 15789 | not published | not published | $925.24 – $6,291.00 | 8 |
| Tcd emboli detect w/inj CPT 93893 | not published | not published | $160.73 – $1,753.43 | 7 |
| Tcd emboli detect without inj CPT 93892 | not published | not published | $160.73 – $1,758.14 | 7 |
| Tcd vasoreactivity study CPT 93890 | not published | not published | $1,416.69 – $1,612.42 | 3 |
| T-cell depletion of harvest CPT 38210 | not published | not published | $660.80 – $6,291.00 | 8 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $237.50 | $475.00 | $46.98 – $380.00 | 18 |
| T cells absolute cd 4 count CPT 86361 | $95.00 | $190.00 | $26.78 – $152.00 | 18 |
| T cells total count CPT 86359 | $187.50 | $375.00 | $37.73 – $300.00 | 18 |
| Tcranial magn stim tx deli CPT 90868 | $425.00 | $850.00 | $334.90 – $1,556.00 | 18 |
| Tcranial magn stim tx plan CPT 90867 | $595.00 | $1,190.00 | $468.86 – $1,556.00 | 18 |
| Tcran magn stim redetemine CPT 90869 | $595.00 | $1,190.00 | $468.86 – $1,556.00 | 18 |
| Tdh sdrl/ventr pnxr CPT 61105 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Teaec w/wo patch graft iliofemoral CPT 35355 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Team conf without pat by hc pro CPT 99368 | $130.00 | $260.00 | $90.74 – $227.80 | 14 |
| Team conf without pat by phys CPT 99367 | $145.00 | $290.00 | $101.21 – $348.40 | 14 |
| Team conf w/pat by hc prof CPT 99366 | $130.00 | $260.00 | $86.68 – $272.47 | 14 |
| Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution HCPCS J9274 | not published | not published | $314.78 – $725.21 | 10 |
| Tee w or without fol w/cont,cong HCPCS C8926 | not published | not published | $1,194.18 – $1,581.26 | 4 |
| Tee w or without fol w/cont, mon HCPCS C8927 | not published | not published | $1,194.18 – $1,581.26 | 4 |
| Teflon or equal cable lining HCPCS L6665 | not published | not published | $80.14 – $197.43 | 7 |
| Telavancin injection HCPCS J3095 | not published | not published | $10.83 – $23.86 | 10 |
| Telehealth original site facility fee HCPCS Q3014 | $37.50 | $75.00 | $26.18 – $60.00 | 13 |
| Telethx isodose plan cplx CPT 77307 | $1,655.00 | $3,310.00 | $553.32 – $2,648.00 | 18 |
| Telethx isodose plan simple CPT 77306 | $970.00 | $1,940.00 | $425.42 – $2,429.00 | 18 |
| Temozolomide HCPCS J8700 | not published | not published | $0.38 – $40.29 | 9 |
| Temozolomide 100 mg intravenous solution HCPCS J9328 | not published | not published | $15.07 – $35.15 | 10 |
| Temperature gradient studies CPT 93740 | not published | not published | $61.96 – $313.15 | 7 |
| Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln HCPCS J9330 | not published | not published | $46.81 – $103.94 | 10 |
| Tendon lengthening CPT 26476 | not published | not published | $3,126.00 – $6,493.91 | 8 |
| Tendon lngth upr a/e ea tdn CPT 24305 | not published | not published | $4,904.26 – $17,439.00 | 8 |
| Tendon shortening CPT 26477 | not published | not published | $3,126.00 – $6,493.91 | 8 |
| Tendon transfer with graft CPT 26492 | not published | not published | $4,904.26 – $17,439.00 | 8 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $313.55 | $627.09 | $218.90 – $532.25 | 18 |
| Teniposide, 50 mg HCPCS Q2017 | not published | not published | $1,714.07 – $10,123.57 | 9 |
| Tenodesis biceps tdn at elbw CPT 24340 | not published | not published | $9,155.00 – $18,102.00 | 8 |
| Tenolysis extensor tendon hand/finger each CPT 26445 | not published | not published | $3,126.00 – $6,493.91 | 8 |
| Tenolysis triceps CPT 24332 | not published | not published | $4,904.26 – $17,439.00 | 8 |
| Tenoplasty elbow to sho 1 CPT 24320 | not published | not published | $8,821.00 – $17,439.00 | 8 |
| Tenosynovectomy radic 26145 CPT 26145 | not published | not published | $2,419.03 – $6,181.00 | 8 |
| Tenotomy hip flexor open CPT 27005 | not published | not published | $12,700.00 – $25,111.00 | 4 |
| Tenotomy length/rls abductor hallucis musc 28240 CPT 28240 | not published | not published | $4,904.26 – $12,362.00 | 8 |
| Tenotomy open tndn flxr toe sgl tndn spx CPT 28232 | not published | not published | $2,419.03 – $12,362.00 | 8 |
| Tension based scoliosis orth HCPCS L1005 | not published | not published | $5,591.68 – $13,623.22 | 7 |
| Tens suppl 2 lead per month HCPCS A4595 | not published | not published | $17.97 – $141.03 | 7 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | not published | not published | $4.54 – $12.37 | 6 |
| Teriparatide injection HCPCS J3110 | not published | not published | $42.43 – $236.53 | 9 |
| Term dev auto grasp feature HCPCS L6881 | not published | not published | $7,156.34 – $17,435.66 | 7 |
| Term device, multi art digit HCPCS L6715 | not published | not published | $5,526.49 – $7,317.83 | 4 |
| Term dev mech hand vol close HCPCS L6709 | not published | not published | $2,434.03 – $5,932.54 | 7 |
| Term dev mech hand vol open HCPCS L6708 | not published | not published | $1,715.00 – $4,179.10 | 7 |
| Term dev mech hook vol close HCPCS L6707 | not published | not published | $2,594.43 – $6,322.72 | 7 |
| Term dev mech hook vol open HCPCS L6706 | not published | not published | $733.40 – $1,786.34 | 7 |
| Term dev modifier wrist unit HCPCS L6805 | not published | not published | $671.35 – $1,635.92 | 7 |
| Term dev, passive hand mitt HCPCS L6703 | not published | not published | $612.26 – $1,490.19 | 7 |
| Term dev precision pinch dev HCPCS L6810 | not published | not published | $356.90 – $869.68 | 7 |
| Term dev, sport/rec/work att HCPCS L6704 | not published | not published | $1,181.82 – $2,881.65 | 7 |
| Tert gene targeted seq alys CPT 81345 | $327.50 | $655.00 | $185.20 – $842.28 | 18 |
| Test for chlorohydrocarbons CPT 82441 | $95.00 | $190.00 | $6.01 – $152.00 | 18 |
| Test for porphobilinogen CPT 84106 | not published | not published | $5.82 – $26.79 | 14 |
| Test for urine cystines CPT 82615 | not published | not published | $9.55 – $47.01 | 14 |
| Testicular imaging w/vasc flow CPT 78761 | not published | not published | $607.37 – $1,297.44 | 8 |
| Testosterone pellet 75 mg HCPCS S0189 | not published | not published | $214.48 – $352.57 | 5 |
| Testosterone response panel CPT 80414 | not published | not published | $51.64 – $282.06 | 14 |
| Testosterone undecanoate 1mg HCPCS J3145 | not published | not published | $2.89 – $6.39 | 10 |
| Test pathogen(s) for platelets reference HCPCS P9100 | $60.00 | $120.00 | $35.50 – $165.54 | 18 |
| Test sock elbw disart/above HCPCS L6682 | not published | not published | $595.23 – $1,452.58 | 7 |
| Test socket above knee HCPCS L5624 | not published | not published | $698.86 – $1,701.72 | 7 |
| Test socket below knee HCPCS L5620 | not published | not published | $518.93 – $1,264.53 | 7 |
| Test socket hemipelvectomy HCPCS L5628 | not published | not published | $1,120.36 – $2,731.23 | 7 |
| Test socket hip disarticulat HCPCS L5626 | not published | not published | $1,106.36 – $2,693.62 | 7 |
| Test socket knee disarticula HCPCS L5622 | not published | not published | $699.12 – $1,701.72 | 7 |
| Test socket shldr disart/tho HCPCS L6684 | not published | not published | $808.84 – $1,969.68 | 7 |
| Test socket symes HCPCS L5618 | not published | not published | $584.87 – $1,424.37 | 7 |
| Test sock wrist disart/bel e HCPCS L6680 | not published | not published | $538.36 – $1,311.55 | 7 |
| Test stress cardiovascular tracing only CPT 93017 | $575.00 | $1,150.00 | $321.00 – $920.00 | 18 |
| Test urine for lactose CPT 83633 | not published | not published | $11.25 – $50.60 | 14 |
| Test urine for porphyrins CPT 84119 | not published | not published | $13.36 – $61.01 | 11 |
| Test urine urobilinogen CPT 84578 | not published | not published | $4.47 – $20.83 | 14 |
| Tetanus ig im CPT 90389 | not published | not published | $1,285.35 – $2,633.02 | 6 |
| Tetanus immune globulin inj HCPCS J1670 | not published | not published | $836.72 – $1,909.43 | 13 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | not published | not published | $26.54 – $61.65 | 10 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.