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 |
|---|---|---|---|---|
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | $675.00 | $1,350.00 | $367.61 – $6,291.00 | 18 |
| Perq skel fix rad/uln dislc CPT 25671 | not published | not published | $4,904.26 – $12,362.00 | 8 |
| Perq skel fix ulnar styld fx CPT 25651 | not published | not published | $4,904.26 – $12,362.00 | 8 |
| Perq transcath closure each CPT 93592 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Perq transcath closure pda CPT 93582 | $17,610.00 | $35,220.00 | $13,876.68 – $91,059.00 | 18 |
| Perq transcath cls aortic CPT 93591 | $18,420.00 | $36,840.00 | $14,514.96 – $97,131.00 | 18 |
| Perq transcath cls mitral CPT 93590 | $18,420.00 | $36,840.00 | $14,514.96 – $97,131.00 | 18 |
| Perq transcath septal reduxn CPT 93583 | $11,810.00 | $23,620.00 | $3,181.00 – $18,896.00 | 14 |
| Perq trluml angp nt/recr coa CPT 33897 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Perq tx big toe fracture w/manip 28496 CPT 28496 | not published | not published | $4,904.26 – $12,362.00 | 8 |
| Perq tx malar fracture CPT 21355 | not published | not published | $4,901.93 – $18,102.00 | 8 |
| Perq tx mndblr fx xtrnl fixj CPT 21452 | not published | not published | $3,126.00 – $11,839.88 | 8 |
| Perq tx nasoethmoid fx CPT 21340 | not published | not published | $4,901.93 – $18,102.00 | 8 |
| Pertussis ag if CPT 87265 | not published | not published | $11.98 – $65.81 | 14 |
| Pertuzumab 30 mg/ml desensitization HCPCS J9306 | not published | not published | $24.49 – $53.91 | 10 |
| Pertuzu, trastuzu, 10 mg HCPCS J9316 | not published | not published | $91.91 – $224.16 | 10 |
| Pessary 3.5 in 7 vag sil rng fold HCPCS A4562 | not published | not published | $103.17 – $249.15 | 7 |
| Pessary reusable rub anytype HCPCS A4561 | not published | not published | $41.53 – $103.41 | 7 |
| Pet CT skull-mid thgh initial CPT 78815 | $4,850.00 | $9,700.00 | $1,980.00 – $8,723.14 | 18 |
| Pet CT whole body initial CPT 78816 | $4,850.00 | $9,700.00 | $1,980.00 – $8,741.02 | 18 |
| Pet fdg brain metoblic eval sb CPT 78608 | $4,850.00 | $9,700.00 | $1,980.00 – $8,446.23 | 18 |
| Pet image full body CPT 78813 | not published | not published | $2,204.67 – $9,068.04 | 8 |
| Pet image ltd area CPT 78811 | not published | not published | $1,973.24 – $6,769.80 | 5 |
| Pet image skull-thigh CPT 78812 | not published | not published | $2,204.67 – $9,058.64 | 8 |
| Pet image w/ct lmtd CPT 78814 | $4,850.00 | $9,700.00 | $1,980.00 – $8,674.02 | 18 |
| Pet not otherwise specified HCPCS G0235 | not published | not published | $607.37 – $8,922.33 | 7 |
| Pet scan brain perf study CPT 78609 | not published | not published | $6,793.90 – $8,870.61 | 4 |
| Pfc sigma fem post aug sz3 8mm HCPCS C1776 | $18,827.50 | $37,655.00 | $73.98 – $177.20 | 14 |
| Ph1 assmt&mgmt nqhp 11-20 CPT 98967 | $82.50 | $165.00 | $36.06 – $138.47 | 18 |
| Ph1 assmt&mgmt nqhp 21-30 CPT 98968 | $110.00 | $220.00 | $49.31 – $201.00 | 18 |
| Ph1 assmt&mgmt nqhp 5-10 CPT 98966 | $50.00 | $100.00 | $19.47 – $80.00 | 18 |
| Phalangectomy ea toe 28150 CPT 28150 | not published | not published | $4,904.26 – $12,362.00 | 8 |
| Pharmacologic management w/psytx CPT 90863 | not published | not published | $309.78 – $352.57 | 3 |
| Ph body fluid CPT 83986 | $27.50 | $55.00 | $3.58 – $32.00 | 18 |
| Phencyclidine (pcp) CPT 83992 | $212.50 | $425.00 | $43.31 – $340.00 | 14 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | $72.45 | $144.90 | $54.07 – $114.89 | 14 |
| Phenobarbital therapeutic drug level CPT 80184 | $77.50 | $155.00 | $15.30 – $124.00 | 18 |
| Phentolaine mesylate inj HCPCS J2760 | not published | not published | $276.73 – $1,349.74 | 13 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | $9.37 | $18.73 | $0.02 – $0.06 | 14 |
| Phenylep ketorolac opth soln HCPCS J1097 | not published | not published | $147.25 – $478.61 | 10 |
| Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1165 | not published | not published | $0.83 – $1.69 | 6 |
| Phenytoin total therapeutic drug level CPT 80185 | $100.00 | $200.00 | $13.25 – $160.00 | 18 |
| Phlebotomy therapeutic CPT 99195 | $207.50 | $415.00 | $144.84 – $388.60 | 18 |
| Phleb veins 1 extrm 10-20 stab CPT 37765 | $3,785.00 | $7,570.00 | $2,982.58 – $17,439.00 | 18 |
| Phleb veins 1 extrm >20 stab CPT 37766 | $4,355.00 | $8,710.00 | $3,431.74 – $17,439.00 | 18 |
| Phone e/m phys/qhp 11-20 min CPT 99442 | not published | not published | $152.83 – $173.94 | 3 |
| Phone e/m phys/qhp 21-30 min CPT 99443 | not published | not published | $223.04 – $253.85 | 3 |
| Phone e/m phys/qhp 5-10 min CPT 99441 | not published | not published | $82.60 – $94.02 | 3 |
| Phosphorus CPT 84100 | $35.00 | $70.00 | $4.74 – $56.00 | 18 |
| Phosphorus 24 hour urine CPT 84105 | $57.50 | $115.00 | $5.78 – $64.00 | 18 |
| Photchmtx tar&uvb/ptrltm&uvb CPT 96910 | not published | not published | $89.78 – $413.69 | 7 |
| Photochemotherapy puva CPT 96912 | not published | not published | $89.78 – $531.21 | 7 |
| Photochemotherapy uv-a or b CPT 96913 | not published | not published | $603.89 – $803.85 | 7 |
| Photodynamic tx addl 15 min CPT 96571 | not published | not published | $165.21 – $6,291.00 | 7 |
| Photodynmc tx 30 min add-on CPT 96570 | not published | not published | $359.34 – $6,291.00 | 7 |
| Photo patch test CPT 95052 | not published | not published | $41.31 – $118.89 | 7 |
| Photopheresis CPT 36522 | not published | not published | $7,081.68 – $18,102.00 | 8 |
| Photosensitivity tests CPT 95056 | not published | not published | $194.12 – $257.99 | 7 |
| Phys blood bank serv authrj CPT 86079 | not published | not published | $49.47 – $310.25 | 14 |
| Phys blood bank serv reactj CPT 86078 | $285.00 | $570.00 | $133.94 – $456.00 | 18 |
| Phys blood bank serv xmatch CPT 86077 | not published | not published | $22.99 – $300.85 | 14 |
| Physical Therapy Evaluation (high complexity) CPT 97163 | $212.50 | $425.00 | $33.49 – $469.00 | 18 |
| Physical Therapy Evaluation (low complexity) CPT 97161 | $207.50 | $415.00 | $29.55 – $469.00 | 18 |
| Physical Therapy Evaluation (moderate complexity) CPT 97162 | $210.00 | $420.00 | $31.52 – $469.00 | 18 |
| Physical Therapy Re-Evaluation CPT 97164 | $120.00 | $240.00 | $23.64 – $469.00 | 18 |
| Physician standby services CPT 99360 | not published | not published | $384.11 – $437.18 | 3 |
| Phys review of motion tests CPT 96004 | not published | not published | $615.41 – $700.43 | 3 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | $124.48 | $248.96 | $4.70 – $199.17 | 14 |
| Pierce earlobes 69090 CPT 69090 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Piflu f-18, dia 1 millicurie HCPCS A9595 | $574.45 | $1,148.89 | $452.66 – $2,079.11 | 18 |
| Pik3ca gene trgt seq alys CPT 81309 | not published | not published | $274.83 – $1,248.53 | 10 |
| Pild/placebo control clin tr HCPCS G0276 | not published | not published | $10,797.81 – $25,111.00 | 8 |
| Pillow shldr abduc inflat univ HCPCS L3960 | not published | not published | $1,268.11 – $3,088.49 | 7 |
| Pinch graft 1/mlt c> sm ulcer tip/oth area 2cm 15050 CPT 15050 | not published | not published | $925.24 – $6,291.00 | 8 |
| Pin finger dislocation CPT 26776 | not published | not published | $4,904.26 – $12,362.00 | 8 |
| Pin finger fracture each CPT 26756 | not published | not published | $4,904.26 – $12,362.00 | 8 |
| Pin hand dislocation CPT 26676 | not published | not published | $4,904.26 – $12,362.00 | 8 |
| Pin knuckle dislocation CPT 26706 | not published | not published | $3,126.00 – $6,493.91 | 8 |
| Pin service 60m per month HCPCS G0023 | not published | not published | $139.81 – $185.13 | 4 |
| Pinworm exam CPT 87172 | $22.50 | $45.00 | $4.27 – $36.00 | 18 |
| Pinworm examinations HCPCS Q0113 | not published | not published | $4.27 – $32.91 | 13 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $23.66 | $47.32 | $1.95 – $31.27 | 14 |
| Pituitary evaluation panel CPT 80418 | not published | not published | $579.48 – $3,173.12 | 14 |
| Place breast cath for rad CPT 19297 | not published | not published | $12,700.00 – $25,111.00 | 4 |
| Place breast rad tube/caths CPT 19298 | not published | not published | $9,857.25 – $25,111.00 | 8 |
| Place cath intracranial art CPT 36228 | $2,380.00 | $4,760.00 | $1,796.64 – $6,291.00 | 14 |
| Place cath xtrnl carotid CPT 36227 | $2,765.00 | $5,530.00 | $1,761.18 – $6,291.00 | 14 |
| Place cecostomy tube perc CPT 49442 | not published | not published | $1,782.19 – $6,181.00 | 8 |
| Place device/marker, non pro HCPCS C9728 | $1,870.00 | $3,740.00 | $1,305.26 – $2,992.00 | 18 |
| Place duod/jej tube perc CPT 49441 | $2,130.00 | $4,260.00 | $1,678.44 – $6,181.00 | 18 |
| Place endorectal app HCPCS C9725 | not published | not published | $1,378.06 – $6,071.00 | 8 |
| Place gastrostomy tube open 43832 CPT 43832 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Place gastrostomy tube perc CPT 49440 | $2,685.00 | $5,370.00 | $2,115.78 – $6,181.00 | 18 |
| Placement bile duct support CPT 47801 | $2,030.00 | $4,060.00 | $1,599.64 – $6,291.00 | 14 |
| Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides) CPT 19281 | $1,070.00 | $2,140.00 | $843.16 – $6,181.00 | 18 |
| Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left CPT 19282 | $800.00 | $1,600.00 | $630.40 – $6,291.00 | 14 |
| Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides) CPT 19285 | $1,250.00 | $2,500.00 | $985.00 – $6,071.00 | 18 |
| Placement nephrostomy catheter (both sides) CPT 50432 | $3,850.00 | $7,700.00 | $2,021.22 – $12,362.00 | 18 |
| Placement occlusive device venous/arterial access site post procedure HCPCS G0269 | $625.00 | $1,250.00 | $492.50 – $6,291.00 | 14 |
| Placement of drain pancreas CPT 48001 | not published | not published | $3,181.00 – $6,291.00 | 4 |
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.