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 |
|---|---|---|---|---|
| Postop dsg cast chg elb dis/ HCPCS L6382 | not published | not published | $2,951.24 – $7,192.39 | 7 |
| Postop dsg cast chg wrst/elb HCPCS L6380 | not published | not published | $2,479.09 – $6,040.68 | 7 |
| Postop ea cast chg & realign HCPCS L6386 | not published | not published | $818.41 – $1,993.18 | 7 |
| Post-operative body jacket HCPCS L1310 | not published | not published | $3,136.19 – $7,638.97 | 7 |
| Post-op hip abduct custom fa HCPCS L1685 | not published | not published | $1,943.09 – $4,733.82 | 7 |
| Post op service lvrs min 6 HCPCS G0305 | not published | not published | $802.01 – $1,061.97 | 4 |
| Post seg spine instrument/3-6 seg 22842 CPT 22842 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Potassium 24 hour urine CPT 84133 | $50.00 | $100.00 | $4.73 – $56.00 | 18 |
| Potassium chloride 10 meq/100ml in sterile water intravenous piggyback HCPCS J3480 | $6.75 | $13.50 | $0.18 – $5.88 | 14 |
| Potassium hydroxide preps HCPCS Q0112 | not published | not published | $5.83 – $28.21 | 13 |
| Potassium serum/plasma/whole blood CPT 84132 | $37.50 | $75.00 | $4.76 – $44.00 | 18 |
| Pouch clsd w barr attached HCPCS A5051 | not published | not published | $4.18 – $9.40 | 7 |
| Pouch drainable w barrier at HCPCS A5061 | not published | not published | $7.16 – $18.81 | 7 |
| Pouch high output 2pc 50mm red HCPCS A4413 | not published | not published | $11.17 – $37.62 | 7 |
| Pouch ostmy flat lk n 2.5in roll premier 1pc trnsp HCPCS A4388 | not published | not published | $8.83 – $28.21 | 7 |
| Pouch ostmy nb pouchkin ctf HCPCS A5062 | not published | not published | $4.21 – $9.40 | 7 |
| Pouch uros new (both sides) 2.75in clr HCPCS A4432 | not published | not published | $7.26 – $23.51 | 7 |
| Powder prem protct 1oz HCPCS A4371 | not published | not published | $7.40 – $23.51 | 7 |
| Ppp2r2b gen detc abnor allel CPT 81343 | not published | not published | $137.00 – $622.03 | 10 |
| Pq biliary strict dil s&i CPT 74363 | $1,265.00 | $2,530.00 | $220.00 – $2,024.00 | 14 |
| Pq dr cath chg w cont s&i CPT 75984 | $545.00 | $1,090.00 | $220.00 – $872.00 | 14 |
| Pq kyphplsty 1 bdy lumb w/img CPT 22514 | $8,280.00 | $16,560.00 | $6,524.64 – $25,111.00 | 18 |
| Pq thr inj ext pse CPT 36002 | $460.00 | $920.00 | $362.48 – $6,071.00 | 18 |
| Pq vrtbrplst 1 bdy inj crv-thr/lmb-scr w/img addl CPT 22512 | $1,715.00 | $3,430.00 | $1,351.42 – $6,291.00 | 14 |
| Pq vrtbrplst 1 bdy inj crv-thr w/img ini CPT 22510 | $8,245.00 | $16,490.00 | $4,904.26 – $17,439.00 | 18 |
| Pq vrtbrplst 1 bdy inj lmb-scr w/img ini CPT 22511 | $3,895.00 | $7,790.00 | $3,069.26 – $17,439.00 | 18 |
| Pralatrexate injection HCPCS J9307 | not published | not published | $493.56 – $1,011.06 | 10 |
| Pralidoxime 1 gram solution for injection HCPCS J2730 | not published | not published | $171.67 – $550.00 | 9 |
| Pr amput fgr/thumb prim/sec any joint/phal sgl incl neurectomies w dir clsr CPT 26951 | not published | not published | $3,126.00 – $6,493.91 | 8 |
| Pr application of long arm splint CPT 29105 | $370.00 | $740.00 | $238.50 – $6,291.00 | 18 |
| Pr application splint static short arm CPT 29125 | $300.00 | $600.00 | $194.83 – $6,291.00 | 18 |
| Pr assessment emotional/behavioral per instrument brief CPT 96127 | not published | not published | $59.33 – $78.56 | 4 |
| Pr biopsy skin punch single lesion CPT 11104 | $212.50 | $425.00 | $167.45 – $6,291.00 | 18 |
| Pr correction hallux valgus (bunionectomy) with sesamoidectomy when performed with first metatarsal and cuneiform joint arthrodesis any method CPT 28297 | not published | not published | $8,821.00 – $25,752.25 | 8 |
| Pr correction hammertoe CPT 28285 | not published | not published | $4,904.26 – $12,362.00 | 8 |
| Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes CPT 99406 | not published | not published | $45.03 – $79.91 | 7 |
| Prcrd drg 0-5yr or w/anomly CPT 33018 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prcrd drg 6+yr without anomly CPT 33017 | $960.00 | $1,920.00 | $756.48 – $6,291.00 | 14 |
| Pr cystourethroscopy with insertion indwelling ureteral stent CPT 52332 | not published | not published | $5,213.15 – $12,362.00 | 8 |
| Pr discharge day management hospital ip/obs <=30 min on ecounter date CPT 99238 | not published | not published | $326.29 – $371.37 | 3 |
| Pr discharge day management hospital ip/obs > 30 min on encounter date CPT 99239 | not published | not published | $470.86 – $535.91 | 3 |
| Prealbumin CPT 84134 | $85.00 | $170.00 | $14.59 – $136.00 | 18 |
| Pr ecg 12 lead report only CPT 93010 | not published | not published | $57.82 – $65.81 | 3 |
| Pr ecg external < 48 hours continuous recording/storage r&i by a phys/qhp CPT 93227 | not published | not published | $177.60 – $202.13 | 3 |
| Prednisolone acetate inj HCPCS J2650 | not published | not published | $1.04 – $2.35 | 5 |
| Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution HCPCS J7510 | not published | not published | $0.40 – $0.81 | 6 |
| Prednisone 1 mg tablet HCPCS J7512 | $0.38 | $0.76 | $0.02 – $0.61 | 14 |
| Prefab glove for term device HCPCS L6890 | not published | not published | $349.61 – $850.87 | 7 |
| Pregabalin - sendout CPT 80366 | $87.50 | $175.00 | $61.08 – $140.00 | 14 |
| Pr egd flexible transoral w/placement percutaneous gastrostomy tube CPT 43246 | not published | not published | $2,867.32 – $6,181.00 | 8 |
| Pregnancy associated plasma protein-a CPT 84163 | $125.00 | $250.00 | $15.05 – $200.00 | 18 |
| Pregnancy Ultrasound (complete, after first trimester) CPT 76805 | $635.00 | $1,270.00 | $160.73 – $1,016.00 | 18 |
| Pregnancy Ultrasound (first trimester) CPT 76801 | $555.00 | $1,110.00 | $160.73 – $888.00 | 18 |
| Pregnancy Ultrasound (limited) CPT 76815 | $362.50 | $725.00 | $160.73 – $580.00 | 18 |
| Pr e&m preventive medicine initial comprehensive new patient 12-17 years CPT 99384 | not published | not published | $660.85 – $752.15 | 3 |
| Pre-op service lvrs 10-15dos HCPCS G0303 | not published | not published | $470.68 – $623.25 | 4 |
| Pre-op service lvrs 1-9 dos HCPCS G0304 | not published | not published | $802.01 – $1,061.97 | 4 |
| Pre-op service lvrs complete HCPCS G0302 | not published | not published | $802.01 – $1,061.97 | 4 |
| Prep ak ischial direct form HCPCS L5570 | not published | not published | $3,966.07 – $9,665.05 | 7 |
| Prep ak ischial laminated HCPCS L5590 | not published | not published | $5,132.16 – $12,504.41 | 7 |
| Prep ak ischial plast molded HCPCS L5560 | not published | not published | $4,086.46 – $9,956.52 | 7 |
| Prep ak ischial thermo mold HCPCS L5580 | not published | not published | $4,922.47 – $11,992.01 | 7 |
| Preparation for bladder xray CPT 51605 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Preparation palate mold CPT 42280 | not published | not published | $769.74 – $6,291.00 | 8 |
| Prepare donor heart CPT 33944 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prepare donor heart/lung CPT 33933 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prepare donor intestine CPT 44715 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prepare donor lung double CPT 32856 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prepare donor lung single CPT 32855 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prepare embryo for transfer CPT 89255 | not published | not published | $49.47 – $1,689.52 | 11 |
| Prepare heart-aorta conduit CPT 33404 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prepare penis study CPT 54230 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prepare sperm duct x-ray CPT 55300 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep bk ptb laminated socket HCPCS L5540 | not published | not published | $3,586.36 – $8,738.98 | 7 |
| Prep bk ptb open end socket HCPCS L5535 | not published | not published | $3,386.10 – $8,250.09 | 7 |
| Prep bk ptb plaster molded HCPCS L5510 | not published | not published | $3,082.56 – $7,512.05 | 7 |
| Prep bk ptb thermopls molded HCPCS L5530 | not published | not published | $3,632.32 – $8,851.80 | 7 |
| Prep cadaver renal allograft CPT 50323 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep corneal endo allograft CPT 65757 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep donor intestine/artery CPT 44721 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep donor intestine/venous CPT 44720 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep donor liver 3-segment CPT 47144 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep donor liver/arterial CPT 47147 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep donor liver lobe split CPT 47145 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep donor liver/venous CPT 47146 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep donor liver whole CPT 47143 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep donor renal graft CPT 50325 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prepj skn cll ssp agrft 1st CPT 15013 | not published | not published | $10,959.20 – $14,511.49 | 4 |
| Prepj tum cav iort prtl mast CPT 19294 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Pre-plan 3d model w/ccta HCPCS C9793 | not published | not published | $1,537.79 – $2,036.25 | 4 |
| Prep renal graft/arterial CPT 50328 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep renal graft/ureteral CPT 50329 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep renal graft/venous CPT 50327 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Prep skin cell susp, automtd HCPCS C8002 | not published | not published | $10,959.20 – $14,511.49 | 4 |
| Prep skin to 100cm2 other CPT 15004 | not published | not published | $925.24 – $6,291.00 | 8 |
| Prep skin to 100cm2 trk/ext CPT 15002 | not published | not published | $2,764.90 – $6,181.00 | 8 |
| Prep skn trk/ext adl 100cm2 CPT 15003 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Pressure max expiratory/inspiratory CPT 94799 | not published | not published | $236.49 – $313.15 | 4 |
| Pressure treatment esophagus CPT 43460 | not published | not published | $3,181.00 – $6,291.00 | 4 |
| Pressure velocity wire add ves CPT 93572 | $645.00 | $1,290.00 | $508.26 – $6,291.00 | 14 |
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.