Advocate Good Samaritan Hospital — price list

← Hospital overviewVerified from Advocate Good Samaritan Hospital’s published price file

Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Showing the first 1,500 prices from a large file. Search a procedure or code below to narrow the list.

How to read these columns

List: The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
Cash: The discounted self-pay price for paying directly, without insurance.
Negotiated: Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.

These are the hospital’s published reference prices, not a personalized estimate of your bill.

1,500 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
1001638 - SYSTEM CBL 53X23MM SHORT 2 INTGR CBL-RDY TIVANIUM Outpatient	C1713 HCPCS	$3,955	$1,977	$1,321 – $3,164	$9,822
1001644 - CABLE ORTHO COCR 1.8MM 635CM TROCH CRLGE CRIMP Outpatient	C1713 HCPCS	$856	$428	$286 – $685	$9,822
1002609 - KIT CATH 4.7 MM X 75 MM OD 14FR IMPELLA CP VNTRC ASSIST IV Outpatient	0278 RC	$110,750	$55,375	$36,991 – $88,600	—
1003294 - COMPONENT PATELLAR H10 MM OD32 MM PRM NEXGEN PE POR KN Outpatient	C1776 HCPCS	$1,730	$865	$578 – $1,384	—
1003295 - COMPONENT PTLR 10MM 35MM PRM NEXGEN PE POR KN STRL Outpatient	C1776 HCPCS	$1,730	$865	$578 – $1,384	—
1003296 - COMPONENT PATELLAR H10 MM OD38 MM PRM NEXGEN PE POR KN Outpatient	C1776 HCPCS	$1,730	$865	$578 – $1,384	—
1003297 - COMPONENT PATELLAR H10 MM OD41 MM PRM NEXGEN PE POR KN Outpatient	C1776 HCPCS	$1,730	$865	$578 – $1,384	—
1003899 - SCREW BN 6.5MM 15MM TRILOGY SELF TAP STRL HIP ACTB Outpatient	C1713 HCPCS	$155	$77.53	$51.79 – $124	$9,822
1003900 - SCREW BN 6.5MM 20MM TRILOGY SELF TAP STRL HIP ACTB Outpatient	C1713 HCPCS	$155	$77.53	$51.79 – $124	$9,822
1003901 - SCREW BN 6.5MM 25MM TRILOGY SELF TAP STRL HIP Outpatient	C1713 HCPCS	$155	$77.53	$51.79 – $124	$9,822
1003902 - SCREW BN 6.5MM 30MM TRILOGY SELF TAP STRL ACTB Outpatient	C1713 HCPCS	$155	$77.53	$51.79 – $124	$9,822
1003903 - SCREW BN 6.5MM 35MM TRILOGY SELF TAP STRL HIP ACTB Outpatient	C1713 HCPCS	$155	$77.53	$51.79 – $124	$9,822
1003904 - SCREW BN 6.5MM 40MM TRILOGY SELF TAP STRL ACTB Outpatient	C1713 HCPCS	$155	$77.53	$51.79 – $124	$9,822
1003934 - LINER ACTB TRILOGY STD 56MM 36MM PRM MDLR CUP Outpatient	C1776 HCPCS	$2,076	$1,038	$693 – $1,661	—
1004055 - SHELL ACTB OD68 MM HIP REV TIVANIUM Outpatient	C1776 HCPCS	$9,892	$4,946	$3,304 – $7,914	—
1004257 - STEM FEM 117MM 9MM HIP 1214 43MM XTD OFFSET PRM Outpatient	C1776 HCPCS	$7,085	$3,542	$2,366 – $5,668	—
1004325 - FELT CV 6X6IN THK1.65MM PTFE PATCH STRL LF Outpatient	C1768 HCPCS	$2,016	$1,008	$673 – $1,613	—
1004662 - HEAD FEM 0MM 1214 MED 36MM HIP ACTB BIOLOX DELTA Outpatient	C1776 HCPCS	$1,384	$692	$462 – $1,107	—
1004663 - HEAD FEM 3.5MM 1214 LG 36MM HIP ACTB BIOLOX Outpatient	C1776 HCPCS	$1,384	$692	$462 – $1,107	—
1004664 - HEAD FEM 7MM 1214 XL 36MM HIP ACTB BIOLOX DELTA Outpatient	C1776 HCPCS	$1,384	$692	$462 – $1,107	—
1004666 - HEAD FEM 0MM 1214 MED 40MM HIP ACETABULUM BIOLOX Outpatient	C1776 HCPCS	$1,384	$692	$462 – $1,107	—
1004965 - WIRE FX OD.5 MM L160 MM NA LIGATURE BLUNT Outpatient	C1713 HCPCS	$53.65	$26.83	$17.92 – $42.92	$9,822
1005482 - BASEPLATE GLND CMPRH 25MM MINI TPR ADPR RVRS SHLDR Outpatient	C1776 HCPCS	$4,656	$2,328	$1,555 – $3,725	—
1005487 - SHELL ACTB HIP 50MM G7 D HMSPHR LMT HOLE CLR CD Outpatient	C1776 HCPCS	$2,422	$1,211	$809 – $1,938	—
1005488 - SHELL ACTB HIP 52MM G7 E HMSPHR LMT HOLE CLR CD Outpatient	C1776 HCPCS	$2,422	$1,211	$809 – $1,938	—
1005489 - SHELL ACTB HIP 54MM G7 F HMSPHR LMT HOLE CLR CD Outpatient	C1776 HCPCS	$2,422	$1,211	$809 – $1,938	—
1005490 - SHELL ACTB HIP 56MM G7 F HMSPHR LMT HOLE CLR CD Outpatient	C1776 HCPCS	$2,422	$1,211	$809 – $1,938	—
1005491 - SHELL ACTB HIP 58MM G7 G HMSPHR LMT HOLE CLR CD Outpatient	C1776 HCPCS	$2,422	$1,211	$809 – $1,938	—
1005492 - SHELL ACTB HIP 60MM G7 G HMSPHR LMT HOLE CLR CD Outpatient	C1776 HCPCS	$2,422	$1,211	$809 – $1,938	—
1005934 - PLUG SURG H1 IN SM TPR MONO NABSB OD1.35 IN PERFIX PP GROIN Outpatient	C1781 HCPCS	$983	$492	$328 – $786	—