Advocate Good Samaritan Hospital
Advocate Good Samaritan Hospital in Downers Grove, IL publishes cash prices for 45 common procedures listed here, from its own machine-readable price file updated Nov 4, 2025. Click a procedure to compare it with other hospitals nearby.
3815 Highland Avenue, Downers Grove, IL 60515 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN & PELVIS W/DYE | $1,780.00 | $3,560.00 | 50% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN & PELVIS W/DYE | $1,780.00 | $3,560.00 | 50% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O DYE | $785.00 | $1,570.00 | 50% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O DYE | $785.00 | $1,570.00 | 50% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE | $890.00 | $1,780.00 | 50% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/DYE | $890.00 | $1,780.00 | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMOGRAM DX BILATERAL | $282.50 | $565.00 | 50% |
| Diagnostic mammogram, both breasts both sides CPT 77066 MAMMOGRAM SCREEN & DX BILATERAL | $282.50 | $565.00 | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMOGRAM SCREEN & DX BILATERAL | $282.50 | $565.00 | 50% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMOGRAM DX BILATERAL | $282.50 | $565.00 | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAM DX UNILATERAL | $282.50 | $565.00 | 50% |
| Diagnostic mammogram, one breast one side CPT 77065 MAMMOGRAM SCREEN & DX UNILATERAL | $282.50 | $565.00 | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAM DX UNILATERAL | $282.50 | $565.00 | 50% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMOGRAM SCREEN & DX UNILATERAL | $282.50 | $565.00 | 50% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR LOWER EXTREM JOINT W/O DYE | $1,505.00 | $3,010.00 | 50% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR LOWER EXT JOINT BIL WO CONTRAST | $1,880.00 | $3,760.00 | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR LOWER EXTREM JOINT W/O DYE | $1,505.00 | $3,010.00 | 50% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR LOWER EXT JOINT BIL WO CONTRAST | $1,880.00 | $3,760.00 | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR LOWER EXTREM JOINT W/WO DYE | $2,360.00 | $4,720.00 | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR LOWER EXTREM JOINT BIL WO/W CONTRAST | $2,950.00 | $5,900.00 | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR LOWER EXTREM JOINT W/WO DYE | $2,360.00 | $4,720.00 | 50% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR LOWER EXTREM JOINT BIL WO/W CONTRAST | $2,950.00 | $5,900.00 | 50% |
| MRI of the brain, no contrast dye CPT 70551 MR BRAIN SHUNT EVAL LTD WO CON | $1,505.00 | $3,010.00 | 50% |
| MRI of the brain, no contrast dye CPT 70551 MR BRAIN W/O DYE | $1,505.00 | $3,010.00 | 50% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR BRAIN W/O DYE | $1,505.00 | $3,010.00 | 50% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MR BRAIN SHUNT EVAL LTD WO CON | $1,505.00 | $3,010.00 | 50% |
| MRI of the brain, with and without contrast dye CPT 70553 MR BRAIN W/WO DYE | $2,360.00 | $4,720.00 | 50% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MR BRAIN W/WO DYE | $2,360.00 | $4,720.00 | 50% |
| MRI of the lower back, no contrast dye CPT 72148 MR LUMBAR SPINE LTD WO DYE | $1,505.00 | $3,010.00 | 50% |
| MRI of the lower back, no contrast dye CPT 72148 MR LUMBAR SPINE LTD WITHOUT DYE | $1,505.00 | $3,010.00 | 50% |
| MRI of the lower back, no contrast dye CPT 72148 MR L SPINE WO DYE | $1,505.00 | $3,010.00 | 50% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE SURVEY WO CON | $1,505.00 | $3,010.00 | 50% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE SURVEY WO CON | $1,505.00 | $3,010.00 | 50% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR L SPINE WO DYE | $1,505.00 | $3,010.00 | 50% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR LUMBAR SPINE LTD WO DYE | $1,505.00 | $3,010.00 | 50% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MR LUMBAR SPINE LTD WITHOUT DYE | $1,505.00 | $3,010.00 | 50% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB >/=14 WK SINGLE FETUS | $635.00 | $1,270.00 | 50% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB >/=14 WK SINGLE FETUS | $635.00 | $1,270.00 | 50% |
| Screening mammogram, both breasts both sides CPT 77067 MAMMOGRAM SCREENING BILATERAL | $237.50 | $475.00 | 50% |
| Screening mammogram, both breasts one side CPT 77067 MAMMOGRAM SCREENING UNILATERAL | $237.50 | $475.00 | 50% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMOGRAM SCREENING BILATERAL | $237.50 | $475.00 | 50% |
| Screening mammogram, both breasts inpatient one side CPT 77067 MAMMOGRAM SCREENING UNILATERAL | $237.50 | $475.00 | 50% |
| Sleep study in a lab (polysomnography) CPT 95810 PSG 4 OR MORE >=6 YRS INCOMPLETE | $2,105.00 | $4,210.00 | 50% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY 4/> PAREMETERS | $3,235.00 | $6,470.00 | 50% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PSG 4 OR MORE >=6 YRS INCOMPLETE | $2,105.00 | $4,210.00 | 50% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY 4/> PAREMETERS | $3,235.00 | $6,470.00 | 50% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $660.00 | $1,320.00 | 50% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL | $660.00 | $1,320.00 | 50% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN COMPLETE | $970.00 | $1,940.00 | 50% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN COMPLETE | $970.00 | $1,940.00 | 50% |
| X-ray of the lower back, 4 or more views CPT 72110 XR LUMBAR SPINE 4 VIEW MIN | $675.00 | $1,350.00 | 50% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LUMBAR SPINE 4 VIEW MIN | $675.00 | $1,350.00 | 50% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 POC BASIC METABOLIC PANEL | $50.00 | $100.00 | 50% |
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL | $65.00 | $130.00 | 50% |
| Basic metabolic panel (blood test) inpatient CPT 80048 POC BASIC METABOLIC PANEL | $50.00 | $100.00 | 50% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL | $65.00 | $130.00 | 50% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $82.50 | $165.00 | 50% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL | $82.50 | $165.00 | 50% |
| Complete blood count (CBC) with differential CPT 85025 POC CBC W/AUTO DIFF | $37.50 | $75.00 | 50% |
| Complete blood count (CBC) with differential CPT 85025 CBC W/AUTO DIFF | $50.00 | $100.00 | 50% |
| Complete blood count (CBC) with differential inpatient CPT 85025 POC CBC W/AUTO DIFF | $37.50 | $75.00 | 50% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC W/AUTO DIFF | $50.00 | $100.00 | 50% |
| Complete blood count (CBC), no differential CPT 85027 POC CBC WO DIFF | $37.50 | $75.00 | 50% |
| Complete blood count (CBC), no differential CPT 85027 CBC WO DIFF | $50.00 | $100.00 | 50% |
| Complete blood count (CBC), no differential inpatient CPT 85027 POC CBC WO DIFF | $37.50 | $75.00 | 50% |
| Complete blood count (CBC), no differential inpatient CPT 85027 CBC WO DIFF | $50.00 | $100.00 | 50% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $107.50 | $215.00 | 50% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $107.50 | $215.00 | 50% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $82.50 | $165.00 | 50% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $82.50 | $165.00 | 50% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $80.00 | $160.00 | 50% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $80.00 | $160.00 | 50% |
| Obstetric blood test panel CPT 80055 OBSTETRIC PANEL | $187.50 | $375.00 | 50% |
| Obstetric blood test panel inpatient CPT 80055 OBSTETRIC PANEL | $187.50 | $375.00 | 50% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE | $92.50 | $185.00 | 50% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, FREE | $92.50 | $185.00 | 50% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, TOTAL | $107.50 | $215.00 | 50% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, TOTAL | $107.50 | $215.00 | 50% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME | $47.50 | $95.00 | 50% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN TIME | $47.50 | $95.00 | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 POC PROTHROMBIN TIME | $27.50 | $55.00 | 50% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $37.50 | $75.00 | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 POC PROTHROMBIN TIME | $27.50 | $55.00 | 50% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $37.50 | $75.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 NEWBORN TSH | $25.00 | $50.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH | $110.00 | $220.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 NEWBORN TSH | $25.00 | $50.00 | 50% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH | $110.00 | $220.00 | 50% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO WITH MICRO | $35.00 | $70.00 | 50% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO WITH MICRO | $35.00 | $70.00 | 50% |
| Urinalysis without microscope exam, automated CPT 81003 HEMOGLOBIN, URINE | $12.50 | $25.00 | 50% |
| Urinalysis without microscope exam, automated CPT 81003 POC URINALYSIS AUTO W/O MICRO | $22.50 | $45.00 | 50% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO W/O MICRO | $32.50 | $65.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HEMOGLOBIN, URINE | $12.50 | $25.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 POC URINALYSIS AUTO W/O MICRO | $22.50 | $45.00 | 50% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO W/O MICRO | $32.50 | $65.00 | 50% |
| Urinalysis without microscope exam, manual CPT 81002 POC URINE DIPSTICK W/O MICRO | $25.00 | $50.00 | 50% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POC URINE DIPSTICK W/O MICRO | $25.00 | $50.00 | 50% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Left heart catheterization, diagnostic CPT 93452 LHC WO/W LVGRAM | $5,685.00 | $11,370.00 | 50% |
| Left heart catheterization, diagnostic inpatient CPT 93452 LHC WO/W LVGRAM | $5,685.00 | $11,370.00 | 50% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION EPIDURAL L/S W IMAGE | $1,145.00 | $2,290.00 | 50% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJECTION EPIDURAL L/S WITH IMAGE | $1,145.00 | $2,290.00 | 50% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJECTION EPIDURAL L/S WITH IMAGE | $1,145.00 | $2,290.00 | 50% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJECTION EPIDURAL L/S W IMAGE | $1,145.00 | $2,290.00 | 50% |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJECTION EPIDURAL L/S WO IMAGE | $895.00 | $1,790.00 | 50% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJECTION EPIDURAL L/S WO IMAGE | $895.00 | $1,790.00 | 50% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN L/S SNG LVL W CT/FLOURO | $1,220.00 | $2,440.00 | 50% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJECT FORAMEN L/S SINGLE LEVEL WITH CT/FLOURO | $1,220.00 | $2,440.00 | 50% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJECT FORAMEN L/S SINGLE LEVEL WITH CT/FLOURO | $1,220.00 | $2,440.00 | 50% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN L/S SNG LVL W CT/FLOURO | $1,220.00 | $2,440.00 | 50% |
| Prostate biopsy CPT 55700 PROSTATE, NEEDLE BIOPSIES | $2,110.00 | $4,220.00 | 50% |
| Prostate biopsy inpatient CPT 55700 PROSTATE, NEEDLE BIOPSIES | $2,110.00 | $4,220.00 | 50% |
| Removal of a breast lump, open surgery CPT 19120 EXC CYST/ABERRANT BRST TISS | $4,270.00 | $8,540.00 | 50% |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXC CYST/ABERRANT BRST TISS | $4,270.00 | $8,540.00 | 50% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes CPT 90847 PHP FAM THERAPY W/PT 50 MIN | $192.50 | $385.00 | 50% |
| Family therapy with the patient, 50 minutes CPT 90847 PSYCHOTHERAPY FAMILY W/PT 50 MIN | $192.50 | $385.00 | 50% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 PHP FAM THERAPY W/PT 50 MIN | $192.50 | $385.00 | 50% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 PSYCHOTHERAPY FAMILY W/PT 50 MIN | $192.50 | $385.00 | 50% |
| Group psychotherapy session CPT 90853 OP CONTINUING CARE | $177.50 | $355.00 | 50% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY | $192.50 | $385.00 | 50% |
| Group psychotherapy session CPT 90853 IOP GROUP THERAPY | $192.50 | $385.00 | 50% |
| Group psychotherapy session CPT 90853 IOP PROCESS THERAPY | $192.50 | $385.00 | 50% |
| Group psychotherapy session CPT 90853 INTENSIVE OUTPATIENT PROGRAM | $625.00 | $1,250.00 | 50% |
| Group psychotherapy session CPT 90853 PARTIAL HOSPITAL PROGRAM | $965.00 | $1,930.00 | 50% |
| Group psychotherapy session inpatient CPT 90853 OP CONTINUING CARE | $177.50 | $355.00 | 50% |
| Group psychotherapy session inpatient CPT 90853 IOP GROUP THERAPY | $192.50 | $385.00 | 50% |
| Group psychotherapy session inpatient CPT 90853 IOP PROCESS THERAPY | $192.50 | $385.00 | 50% |
| Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY | $192.50 | $385.00 | 50% |
| Group psychotherapy session inpatient CPT 90853 INTENSIVE OUTPATIENT PROGRAM | $625.00 | $1,250.00 | 50% |
| Group psychotherapy session inpatient CPT 90853 PARTIAL HOSPITAL PROGRAM | $965.00 | $1,930.00 | 50% |
| New patient office visit, about 30 minutes CPT 99203 OSTM OP SERV MOD ACUITY-NEW PT | $147.50 | $295.00 | 50% |
| New patient office visit, about 30 minutes CPT 99203 OP SERV MOD ACUITY-NEW PT | $147.50 | $295.00 | 50% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OP SERV MOD ACUITY-NEW PT | $147.50 | $295.00 | 50% |
| New patient office visit, about 30 minutes inpatient CPT 99203 OSTM OP SERV MOD ACUITY-NEW PT | $147.50 | $295.00 | 50% |
| New patient office visit, about 45 minutes CPT 99204 OP SERV HIGH ACUITY-NEW PT | $177.50 | $355.00 | 50% |
| New patient office visit, about 45 minutes CPT 99204 OSTM OP SERV HIGH ACUITY-NEW PT | $177.50 | $355.00 | 50% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OSTM OP SERV HIGH ACUITY-NEW PT | $177.50 | $355.00 | 50% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OP SERV HIGH ACUITY-NEW PT | $177.50 | $355.00 | 50% |
| New patient office visit, about 60 minutes CPT 99205 OSTM OP SERV COMP ACUITY-NEW PT | $207.50 | $415.00 | 50% |
| New patient office visit, about 60 minutes CPT 99205 OP SERV COMP ACUITY-NEW PT | $207.50 | $415.00 | 50% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OP SERV COMP ACUITY-NEW PT | $207.50 | $415.00 | 50% |
| New patient office visit, about 60 minutes inpatient CPT 99205 OSTM OP SERV COMP ACUITY-NEW PT | $207.50 | $415.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXER PER UNIT | $85.00 | $170.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 PEDS THER EXERCISE PER 15" | $85.00 | $170.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PEDS THER EXERCISE PER 15" | $85.00 | $170.00 | 50% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXER PER UNIT | $85.00 | $170.00 | 50% |
| Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY 30 MIN W/PT | $200.00 | $400.00 | 50% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY 30 MIN W/PT | $200.00 | $400.00 | 50% |