Gottlieb Memorial Hospital
Gottlieb Memorial Hospital in Melrose Park, IL publishes cash prices for 51 common procedures listed here, from its own machine-readable price file updated Mar 31, 2026. Click a procedure to compare it with other hospitals nearby.
701 W. North Ave, Melrose Park, IL 60160 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 Abd & Pelvis W/ Contrast | $1,101.05 | $5,795.00 | 81% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head W/O Contrast | $475.19 | $2,501.00 | 81% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis W/Contrast | $566.01 | $2,979.00 | 81% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Mammogram Digtl Diag W/ or W/O Cad Bilat | $166.63 | $877.00 | 81% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Mammogram Digtl Diag W/ or W/O Cad Bilat Recall | $166.63 | $877.00 | 81% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Mammogram Digtl Diag Same Day as Scrn W/ or W/O Cad Bilat | $166.63 | $877.00 | 81% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammogram Digtl Diag W/ or W/O Cad Unilat Rt Recall | $142.31 | $749.00 | 81% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammogram Digtl Diag W/ or W/O Cad Unilat Lt | $142.31 | $749.00 | 81% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammogram Digtl Diag W/ or W/O Cad Unilat Rt | $142.31 | $749.00 | 81% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammogram Digtl Diag Same Day as Scrn W/ or W/O Cad Unil Lt | $142.31 | $749.00 | 81% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammogram Digtl Diag W/ or W/O Cad Unilat Lt Recall | $142.31 | $749.00 | 81% |
| Diagnostic mammogram, one breast one side CPT 77065 Mammogram Digtl Diag Same Day as Scrn W/ or W/O Cad Unil Rt | $142.31 | $749.00 | 81% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 HC MR Low Ext Joint W/O Con Bilat | $1,233.48 | $6,492.00 | 81% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Low Ext Joint W/O Con Rt | $822.32 | $4,328.00 | 81% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MR Low Ext Joint W/O Con Lt | $822.32 | $4,328.00 | 81% |
| MRI of knee or other lower-limb joint, without and then with contrast dye both sides CPT 73723 HC MR Low Ext Joint W&W/O Con Bilat | $1,433.93 | $7,547.00 | 81% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR Low Ext Joint W&W/O Con Rt | $955.89 | $5,031.00 | 81% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MR Low Ext Joint W&W/O Con Lt | $955.89 | $5,031.00 | 81% |
| MRI of the brain, no contrast dye CPT 70551 MR Scan Brain/Head WO/Cont | $752.78 | $3,962.00 | 81% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Scan Brain-W/WO Cont | $994.84 | $5,236.00 | 81% |
| MRI of the brain, with and without contrast dye CPT 70553 Stereo Brain Radio-Surg Protocol | $994.84 | $5,236.00 | 81% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Scan Sella/Pit-W/WO Co | $994.84 | $5,236.00 | 81% |
| MRI of the brain, with and without contrast dye CPT 70553 MR Scan Cpa/Iac-W/WO Cont | $994.84 | $5,236.00 | 81% |
| MRI of the lower back, no contrast dye CPT 72148 MR Scan Spine Lumb-WO/Con | $783.37 | $4,123.00 | 81% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 U/S Pregnancy > 14 Wks | $223.63 | $1,177.00 | 81% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 U/S Preg > 14 Wks Sing Gest | $223.63 | $1,177.00 | 81% |
| Screening mammogram, both breasts both sides CPT 77067 Mammogram Digtl Scrn W/ or W/O Cad 2vw Ea Bilat | $139.27 | $733.00 | 81% |
| Screening mammogram, both breasts one side CPT 77067 HC Mammo Breast Screening Unilateral (Mod-52) | $132.24 | $696.00 | 81% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysomnogram Age 6 & Abv 4 or > Param Att Tech | $1,058.68 | $5,572.00 | 81% |
| Transvaginal pelvic ultrasound CPT 76830 U/S Transvaginal (Fc) | $218.69 | $1,151.00 | 81% |
| Transvaginal pelvic ultrasound CPT 76830 U/S Endovaginal | $218.69 | $1,151.00 | 81% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Exam Abdom Complete W/Mod-59 | $344.09 | $1,811.00 | 81% |
| Ultrasound of the abdomen, complete CPT 76700 U/S Abdominal Complete (Fc) | $344.09 | $1,811.00 | 81% |
| Ultrasound of the abdomen, complete CPT 76700 U/S Abdominal, Complete | $344.09 | $1,811.00 | 81% |
| X-ray of the lower back, 4 or more views CPT 72110 Spine Lumbosac Min 4 Vw Flex/Ext Stand Ortho | $190.76 | $1,004.00 | 81% |
| X-ray of the lower back, 4 or more views CPT 72110 Spine Lumbosac Min 4 Vw Flex/Ext Ortho | $190.76 | $1,004.00 | 81% |
| X-ray of the lower back, 4 or more views CPT 72110 Spine Lumbosac Min 4 Vw | $190.76 | $1,004.00 | 81% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel (Bmpp) | $49.97 | $263.00 | 81% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel (Lpr) | $48.64 | $256.00 | 81% |
| Complete blood count (CBC) with differential CPT 85025 Cbc W Automated Diff (Cbcdf) | $28.69 | $151.00 | 81% |
| Complete blood count (CBC), no differential CPT 85027 Cbc Automated W Platelet (Cbc) | $22.23 | $117.00 | 81% |
| Comprehensive metabolic panel (blood test) CPT 80053 Onc Comprehensive Metabol Panel (Onccmp) | $15.01 | $79.00 | 81% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comp Metabolic Panel (Cmpp) | $60.80 | $320.00 | 81% |
| Kidney function blood test panel CPT 80069 Renal Function Panel (Rfpp) | $58.14 | $306.00 | 81% |
| Liver function blood test panel CPT 80076 Liver Function Panel (Lfpp) | $50.16 | $264.00 | 81% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Free Psa (Tfpsa) | $36.29 | $191.00 | 81% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Psa Diagnostic (Psad) | $40.28 | $212.00 | 81% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Psa-Prostate Specif Antifen-Screen (Psa) | $44.08 | $232.00 | 81% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Silica Screen Ratio (Scts) | $24.32 | $128.00 | 81% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Partial Thromboplastin Ti (Ptt | $24.32 | $128.00 | 81% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Coagucheck for Pt / Inr - OP (Fc) | $23.75 | $125.00 | 81% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time (Pt) | $23.75 | $125.00 | 81% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stim Hormone (Tsh) | $56.05 | $295.00 | 81% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh - Pku | $56.05 | $295.00 | 81% |
| Urinalysis with microscope exam, automated CPT 81001 Ua Auto,W/Micro (Muamic) | $53.39 | $281.00 | 81% |
| Urinalysis without microscope exam, automated CPT 81003 U/a by Clinitek (Status) | $13.49 | $71.00 | 81% |
| Urinalysis without microscope exam, automated CPT 81003 Urine Dipstick | $13.49 | $71.00 | 81% |
| Urinalysis without microscope exam, automated CPT 81003 U/a by Clinitek (Status) - OP (Fc) | $13.49 | $71.00 | 81% |
| Urinalysis without microscope exam, automated CPT 81003 U/a Auto W/O Micro (Dipstk) | $13.49 | $71.00 | 81% |
| Urinalysis without microscope exam, automated CPT 81003 U/a by Clinitek (Cdpstk) | $13.49 | $71.00 | 81% |
| Urinalysis without microscope exam, automated CPT 81003 Lab Performed - U/a Clinitek Status | $13.49 | $71.00 | 81% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis Dip | $7.22 | $38.00 | 81% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis, Dipstick - OP | $7.22 | $38.00 | 81% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with endoscopic ultrasound CPT 45391 Colonoscopy Flex W/ Endosc U/S | $367.65 | $1,935.00 | 81% |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy W/Snare Polypect | $811.49 | $4,271.00 | 81% |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy W/Snare Polypect Comb | $811.49 | $4,271.00 | 81% |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy W/Biopsy | $1,018.78 | $5,362.00 | 81% |
| Colonoscopy, diagnostic CPT 45378 Colonoscopy Terminated | $629.66 | $3,314.00 | 81% |
| Colonoscopy, diagnostic CPT 45378 Colonoscopy | $692.74 | $3,646.00 | 81% |
| Colonoscopy, diagnostic CPT 45378 Ca Screen Colonoscopy | $878.18 | $4,622.00 | 81% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC ED Repair Initial Inguinal Hernia 5yrs/> Reducible | $2,065.87 | $10,873.00 | 81% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 Yag Capsulotomy | $316.92 | $1,668.00 | 81% |
| Left heart catheterization, diagnostic CPT 93452 Lt Hrt Cath W/ Inj & Rad S&I | $1,774.22 | $9,338.00 | 81% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Inj Epid Diag/Ther Lumb/Sac W/ Img | $375.63 | $1,977.00 | 81% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Inj Epid Diag/Ther Lumb/Sac W/O Img | $320.34 | $1,686.00 | 81% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj Anes/Ster Trnsfor Epid W/ Fluor Lum/Sac Sing | $458.47 | $2,413.00 | 81% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj Anes Agt/Ster Trnsfor Epid W/ Fluor Lum/Sac Sing | $458.47 | $2,413.00 | 81% |
| Prostate biopsy CPT 55700 Prostate Biopsy Needle/Punch | $823.46 | $4,334.00 | 81% |
| Prostate biopsy CPT 55700 Prostate Biopsy Needle / Punch | $823.46 | $4,334.00 | 81% |
| Prostate biopsy CPT 55700 Biopsy Prostate, Sing/Mult | $823.46 | $4,334.00 | 81% |
| Removal of a breast lump, open surgery CPT 19120 Exc Aberr Breast Tiss Open 1 or More Les | $716.49 | $3,771.00 | 81% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Egd Flex Trnsoral W/ Bx Sing/Mult | $652.46 | $3,434.00 | 81% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Egd Flx Trnsoral W/ Bx Sing/Mult | $652.46 | $3,434.00 | 81% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Egd Flex Trnsoral Diag W/WO Spec Term | $583.30 | $3,070.00 | 81% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Egd Flex Trnsoral Diag W/WO Spec | $632.32 | $3,328.00 | 81% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Group psychotherapy session CPT 90853 Group Psychotherapy Other Than Multi-Family | $52.63 | $277.00 | 81% |
| New patient office visit, about 30 minutes CPT 99203 New Level III | $25.08 | $132.00 | 81% |
| New patient office visit, about 30 minutes CPT 99203 New Level III 30-45 Min | $25.08 | $132.00 | 81% |
| New patient office visit, about 45 minutes CPT 99204 New Level IV | $31.54 | $166.00 | 81% |
| New patient office visit, about 45 minutes CPT 99204 New Level IV 45-60 Min | $31.54 | $166.00 | 81% |
| New patient office visit, about 60 minutes CPT 99205 New Level V > 1 Hr | $46.74 | $246.00 | 81% |
| New patient office visit, about 60 minutes CPT 99205 Tis-I Nurse Visit New | $46.74 | $246.00 | 81% |
| New patient office visit, about 60 minutes CPT 99205 New Level V | $46.74 | $246.00 | 81% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ther Exercise 15 Min Ot | $40.66 | $214.00 | 81% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ther Exercise 15 Min Pt | $40.66 | $214.00 | 81% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Isokinetic Exercise 15 Min Pt | $40.66 | $214.00 | 81% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OP Lactation Serv Fee Comp (60-Min) | $100.13 | $527.00 | 81% |
Source file: https://trinityhealth.pt.panaceainc.com/MRFDownload/trinityhealth/gottliebmemorialhospital