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 |
|---|---|---|---|---|
| Drng salivary gland simple 42300 CPT 42300 | not published | not published | $2,238.97 – $6,181.00 | 8 |
| Drng salivary gland submax/subling 42310 CPT 42310 | not published | not published | $769.74 – $6,291.00 | 8 |
| Dronabinol 2.5mg oral HCPCS Q0167 | not published | not published | $4.44 – $32.91 | 9 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | not published | not published | $18.43 – $37.75 | 6 |
| Drop lock knee HCPCS L2182 | not published | not published | $199.64 – $484.19 | 7 |
| Drop lock retainer each HCPCS L2785 | not published | not published | $51.77 – $126.93 | 7 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $456.82 | $913.64 | $305.16 – $730.91 | 14 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | not published | not published | $20.39 – $41.78 | 9 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | not published | not published | $19.45 – $39.85 | 9 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | not published | not published | $12.94 – $26.50 | 6 |
| Drsg sht 5.625x4.625in std HCPCS A6025 | not published | not published | $103.26 – $117.53 | 3 |
| Drsg surg adh 11x11 3/4 occl drap wnd 28x30 HCPCS A6259 | not published | not published | $22.16 – $51.72 | 7 |
| Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm HCPCS A2008 | not published | not published | $152.69 – $312.79 | 6 |
| Drsg wnd hyalomatrix 10x10cm -cost per sq cm HCPCS Q4117 | not published | not published | $48.78 – $101.16 | 6 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | not published | not published | $61.96 – $167.41 | 9 |
| Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm HCPCS A2007 | not published | not published | $136.77 – $411.40 | 6 |
| Drug admin & hemodynmic meas CPT 93463 | $237.50 | $475.00 | $187.15 – $6,291.00 | 14 |
| Drug assay caffeine CPT 80155 | $80.00 | $160.00 | $38.57 – $175.60 | 18 |
| Drug assay posaconazole CPT 80187 | $100.00 | $200.00 | $27.11 – $160.00 | 18 |
| Drug assay rufinamide CPT 80210 | $170.00 | $340.00 | $27.11 – $272.00 | 18 |
| Drug assay vedolizumab CPT 80280 | $272.50 | $545.00 | $38.57 – $436.00 | 18 |
| Drug assay voriconazole CPT 80285 | $102.50 | $205.00 | $27.11 – $164.00 | 18 |
| Drug asy hydroxychloroquine CPT 80220 | $345.00 | $690.00 | $18.64 – $552.00 | 18 |
| Drug of abuse screen urine CPT 80305 | not published | not published | $12.60 – $79.91 | 13 |
| Drug screen quant tiagabine CPT 80199 | $115.00 | $230.00 | $27.11 – $184.00 | 18 |
| Drug test def 15-21 classes HCPCS G0482 | $322.50 | $645.00 | $198.74 – $516.00 | 18 |
| Drug test def 1-7 classes HCPCS G0480 | not published | not published | $114.43 – $519.35 | 10 |
| Drug test def 22+ classes HCPCS G0483 | $140.00 | $280.00 | $110.32 – $474.09 | 18 |
| Drug test def 8-14 classes HCPCS G0481 | not published | not published | $156.59 – $300.65 | 8 |
| Drug test def simple all cl HCPCS G0659 | not published | not published | $62.14 – $282.74 | 10 |
| Drug test prsmv instrmnt CPT 80306 | not published | not published | $17.14 – $79.91 | 13 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $405.00 | $810.00 | $62.14 – $282.74 | 18 |
| Drvvt confirm - quest CPT 85597 | not published | not published | $17.98 – $98.72 | 14 |
| Dstrj extensive retinopathy CPT 67227 | not published | not published | $5,699.90 – $17,439.00 | 8 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | not published | not published | $2,951.63 – $12,362.00 | 8 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | not published | not published | $603.89 – $6,291.00 | 8 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | not published | not published | $603.89 – $6,291.00 | 8 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $925.24 – $6,291.00 | 8 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $925.24 – $6,291.00 | 8 |
| Dstry eye lesn,fdr vssl tech HCPCS G0186 | not published | not published | $829.21 – $6,071.00 | 8 |
| Ductogram sgl duct CPT 77053 | $670.00 | $1,340.00 | $166.63 – $1,072.00 | 18 |
| Duodenal exclusion CPT 48547 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Duodenal motility study CPT 91022 | not published | not published | $802.01 – $6,291.00 | 11 |
| Duplex scan bilateral study 93985 CPT 93985 | $750.00 | $1,500.00 | $365.36 – $1,331.03 | 18 |
| Duplex scan unilateral study 93986 CPT 93986 | $500.00 | $1,000.00 | $160.73 – $1,010.00 | 18 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $605.00 | $1,210.00 | $160.73 – $1,121.10 | 18 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $740.00 | $1,480.00 | $236.49 – $1,331.03 | 18 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $780.00 | $1,560.00 | $365.36 – $1,433.76 | 18 |
| Duragen 1x1 5ea/bx HCPCS C9354 | not published | not published | $38.76 – $38.76 | 2 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | not published | not published | $123.61 – $276.72 | 10 |
| Dxa bone density axl vrt fx CPT 77085 | not published | not published | $160.73 – $212.83 | 6 |
| Dx aly aud oi snd prcsr 1st CPT 92622 | not published | not published | $236.49 – $474.80 | 7 |
| Dx aly aud oi snd prcsr each CPT 92623 | not published | not published | $104.29 – $118.70 | 3 |
| Dx bronchoscope/brush 31623 CPT 31623 | not published | not published | $2,606.55 – $6,181.00 | 8 |
| Dx bronchoscope/lavage 31624 CPT 31624 | $2,095.00 | $4,190.00 | $84.00 – $3,451.43 | 18 |
| Dx bronchoscope/wash 31622 CPT 31622 | $2,095.00 | $4,190.00 | $84.00 – $3,451.43 | 18 |
| Dx dark adaptation exam i&r CPT 92284 | not published | not published | $603.15 – $798.66 | 4 |
| Dx duod intub w/asp spec 43756 CPT 43756 | not published | not published | $1,417.13 – $6,181.00 | 8 |
| Dx duod intub w/asp specs CPT 43757 | not published | not published | $1,417.13 – $6,181.00 | 8 |
| Dx gastr intub w/asp spec CPT 43754 | not published | not published | $470.68 – $6,291.00 | 8 |
| Dx gastr intub w/asp specs CPT 43755 | not published | not published | $236.49 – $6,291.00 | 8 |
| Dx intraop thoracic aorta Ultrasound CPT 76984 | not published | not published | $351.08 – $399.59 | 3 |
| Dx laryngoscopy newborn CPT 31520 | not published | not published | $586.93 – $6,291.00 | 8 |
| Dx laryngoscopy w/oper scope CPT 31526 | not published | not published | $2,606.55 – $6,181.00 | 8 |
| Dynamic cavernosometry CPT 54231 | not published | not published | $367.61 – $6,181.00 | 8 |
| Dynamic fine wire emg CPT 96003 | not published | not published | $99.13 – $112.82 | 3 |
| Dynamic surface emg CPT 96002 | not published | not published | $470.68 – $623.25 | 4 |
| Ear and throat examination CPT 92502 | not published | not published | $569.99 – $6,291.00 | 11 |
| Ear canal biopsy 69105 CPT 69105 | not published | not published | $2,238.97 – $6,181.00 | 8 |
| Ear cartilage graft CPT 21235 | not published | not published | $3,126.00 – $11,839.88 | 8 |
| Ear irrigation 69209 CPT 69209 | $150.00 | $300.00 | $84.00 – $200.00 | 18 |
| Ear protector evaluation CPT 92596 | not published | not published | $59.33 – $78.56 | 4 |
| Ecallantide injection HCPCS J1290 | not published | not published | $840.98 – $1,902.53 | 10 |
| Ecg/1-3 leads/interp & report only 93042 CPT 93042 | not published | not published | $49.56 – $56.41 | 3 |
| Ecg/1-3 leads/tracing only 93041 CPT 93041 | $177.50 | $355.00 | $89.78 – $330.00 | 18 |
| Ecg < 30 days transmission & analysis CPT 93271 | not published | not published | $138.74 – $1,579.50 | 7 |
| Ecg external < 48 hours recording CPT 93225 | not published | not published | $194.83 – $277.35 | 7 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | not published | not published | $89.78 – $1,142.31 | 7 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | not published | not published | $59.33 – $78.56 | 4 |
| Ecg external >7 days up to 15 days recording CPT 93246 | not published | not published | $59.33 – $78.56 | 4 |
| Ecg record/review CPT 93268 | not published | not published | $1,705.80 – $1,941.48 | 3 |
| Ecg/review interpret only CPT 93272 | not published | not published | $169.34 – $192.74 | 3 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $1,170.00 | $2,340.00 | $781.76 – $1,867.02 | 18 |
| Echocardiogram (Limited Follow-Up Heart Ultrasound) CPT 93308 | $470.00 | $940.00 | $293.16 – $781.65 | 18 |
| Echocardiography doppler color flow mapping CPT 93325 | $217.50 | $435.00 | $171.39 – $1,877.00 | 14 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | not published | not published | $1,194.18 – $1,581.26 | 4 |
| Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast HCPCS C8924 | not published | not published | $539.81 – $714.78 | 4 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $255.00 | $510.00 | $157.05 – $360.00 | 14 |
| Echo exam of eye CPT 76516 | not published | not published | $111.57 – $427.78 | 10 |
| Echo exam of eye CPT 76519 | not published | not published | $160.73 – $455.99 | 10 |
| Echo exam of eye CPT 76529 | not published | not published | $133.09 – $437.18 | 10 |
| Echo exam of eye thickness CPT 76514 | not published | not published | $15.08 – $79.91 | 10 |
| Echo exam of fetal heart CPT 76825 | $1,115.00 | $2,230.00 | $214.00 – $1,784.00 | 18 |
| Echo exam of fetal heart CPT 76826 | $835.00 | $1,670.00 | $214.00 – $1,336.00 | 18 |
| Echo exam of fetal heart CPT 76827 | $580.00 | $1,160.00 | $160.73 – $928.00 | 18 |
| Echo exam of fetal heart CPT 76828 | $437.50 | $875.00 | $102.64 – $700.00 | 18 |
| Echo exam uterus 76831- CPT 76831 | $610.00 | $1,220.00 | $214.00 – $976.00 | 18 |
| Echograp trans r pros study CPT 76873 | $580.00 | $1,160.00 | $160.73 – $1,094.30 | 18 |
| Echo guidance radiotherapy CPT 76965 | $655.00 | $1,310.00 | $214.00 – $1,048.00 | 14 |
| Echo guide cardiocentesis CPT 76930 | not published | not published | $553.46 – $629.93 | 3 |
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.