San Bernardino - Fontana Medical Center
9961 SIERRA AVENUE, FONTANA, CA · Kaiserpermanente · · NPI 1356496772
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 |
|---|---|---|---|---|
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $270.40 | $520.00 | not published | 0 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $390.00 | $750.00 | not published | 0 |
| Administration immunization 1 vaccine CPT 90471 | $104.00 | $200.00 | not published | 0 |
| Administration immunization each additional component CPT 90461 | $63.96 | $123.00 | not published | 0 |
| Administration immunization each additional vaccine CPT 90472 | $52.00 | $100.00 | not published | 0 |
| Administration immunization first component each vaccine CPT 90460 | $91.00 | $175.00 | not published | 0 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | $57.20 | $110.00 | not published | 0 |
| Administration immunization intranasal/oral route each additional vaccine CPT 90474 | $26.00 | $50.00 | not published | 0 |
| Administration vaccine hepatitis b HCPCS G0010 | $104.00 | $200.00 | not published | 0 |
| Administration vaccine influenza virus HCPCS G0008 | $104.00 | $200.00 | not published | 0 |
| Administration vaccine pneumococcal HCPCS G0009 | $104.00 | $200.00 | not published | 0 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | $10,379.83 | $19,961.21 | $42.00 – $42.00 | 1 |
| Adrenal cortex & medulla img CPT 78075 | $2,927.60 | $5,630.00 | $1,185.00 – $1,185.00 | 1 |
| Aep hearing status deter i&r CPT 92651 | $498.16 | $958.00 | not published | 0 |
| Aep neurodiagnostic i&r CPT 92653 | $673.40 | $1,295.00 | not published | 0 |
| Aep thrshld est mlt freq i&r CPT 92652 | $673.40 | $1,295.00 | not published | 0 |
| Afamelanotide implant, 1 mg HCPCS J7352 | $75,495.37 | $145,183.40 | $2,943.00 – $2,943.00 | 1 |
| Afamitresgene autoleucel HCPCS Q2057 | not published | not published | $792,430.00 – $792,430.00 | 1 |
| _afb id by dna probe rflx ast CPT 87149 | $37.96 | $73.00 | $13.00 – $13.00 | 1 |
| #afb mycobacteria suscep. #1 CPT 87190 | $85.28 | $164.00 | $5.00 – $5.00 | 1 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | not published | not published | $79.00 – $79.00 | 1 |
| Aff2 gen aly detc abnl allel CPT 81171 | not published | not published | $57.00 – $57.00 | 1 |
| Aff2 gen alys charac alleles CPT 81172 | not published | not published | $116.00 – $116.00 | 1 |
| Aflibercept injection HCPCS J0178 | $3,153.84 | $6,065.07 | $957.00 – $957.00 | 1 |
| Afo tib fx semi-rigid l2114 HCPCS L2114 | $1,133.60 | $2,180.00 | not published | 0 |
| Afo tibial fracture rigid HCPCS L2116 | $322.40 | $620.00 | not published | 0 |
| After cataract laser surgery CPT 66821 | $1,570.40 | $3,020.00 | not published | 0 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | $12,701.89 | $24,426.71 | $230.00 – $230.00 | 1 |
| Air conduction bilat CPT 92552 | $149.76 | $288.00 | not published | 0 |
| Air injection into abdomen 49400 CPT 49400 | $681.20 | $1,310.00 | not published | 0 |
| Airway resistance by impulse oscillometry 94728 CPT 94728 | $365.04 | $702.00 | not published | 0 |
| Albumin body fluid quantitative each specimen CPT 82042 | $17.16 | $33.00 | $5.00 – $5.00 | 1 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $195.59 | $376.14 | not published | 0 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | $234.94 | $451.80 | not published | 0 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | $275.16 | $529.15 | not published | 0 |
| Albumin ischemia modified CPT 82045 | $263.12 | $506.00 | $24.00 – $24.00 | 1 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $12.48 | $24.00 | $3.00 – $3.00 | 1 |
| Albumin serum plasma or whole blood CPT 82040 | $24.96 | $48.00 | $3.00 – $3.00 | 1 |
| Albuterol ipratrop non-comp HCPCS J7620 | not published | not published | $0.20 – $0.20 | 1 |
| Albuterol non-comp con HCPCS J7611 | not published | not published | $0.16 – $0.16 | 1 |
| Albuterol non-comp unit HCPCS J7613 | not published | not published | $0.08 – $0.08 | 1 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $89.96 | $173.00 | $12.00 – $12.00 | 1 |
| Alcohols biomarkers 3/more CPT 80322 | $130.00 | $250.00 | not published | 0 |
| Alcohol/subs interv 15-30mn HCPCS G0396 | $93.60 | $180.00 | not published | 0 |
| Alcohol/subs interv >30 min HCPCS G0397 | $342.16 | $658.00 | not published | 0 |
| Aldesleukin injection HCPCS J9015 | $9,030.11 | $17,365.59 | $5,301.00 – $5,301.00 | 1 |
| Aldosterone suppression eval CPT 80408 | not published | not published | $86.00 – $86.00 | 1 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | $44,547.57 | $85,668.41 | $2,440.00 – $2,440.00 | 1 |
| Alginate dressing <=16 sq in HCPCS A6196 | $11.44 | $22.00 | not published | 0 |
| Alginate drsg >16 <=48 sq in HCPCS A6197 | $40.60 | $78.08 | not published | 0 |
| Alginate drsg wound filler HCPCS A6199 | $14.66 | $28.20 | not published | 0 |
| Alkaline phosphatase CPT 84075 | $46.80 | $90.00 | $3.00 – $3.00 | 1 |
| Allergen alpha lactalbumin ige CPT 86008 | $38.48 | $74.00 | $12.00 – $12.00 | 1 |
| Allergen egg white ige CPT 86003 | $8.32 | $16.00 | $3.00 – $3.00 | 1 |
| Allergen specific ige qual multi scrn ea CPT 86005 | $34.84 | $67.00 | $5.00 – $5.00 | 1 |
| Allergy injections; 2 or more 95117 CPT 95117 | $73.84 | $142.00 | not published | 0 |
| Allergy injection; single 95115 CPT 95115 | $73.84 | $142.00 | not published | 0 |
| Allergy Skin Testing CPT 95004 | $566.28 | $1,089.00 | not published | 0 |
| Allg patch or app # of tests 95044 CPT 95044 | $263.64 | $507.00 | not published | 0 |
| Allgrft implnt knee w/scope CPT 29867 | $6,411.60 | $12,330.00 | not published | 0 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | $5,399.16 | $10,383.00 | not published | 0 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | $4,475.14 | $8,606.04 | not published | 0 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $4,841.20 | $9,310.00 | not published | 0 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $10,939.50 | $21,037.50 | not published | 0 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $4,803.50 | $9,237.50 | not published | 0 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $4,343.30 | $8,352.50 | not published | 0 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $5,096.00 | $9,800.00 | not published | 0 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $4,071.60 | $7,830.00 | not published | 0 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $4,173.00 | $8,025.00 | not published | 0 |
| All tstg perq&iq drugs/biol CPT 95018 | $116.48 | $224.00 | not published | 0 |
| All tstg perq&iq w/venoms CPT 95017 | $73.32 | $141.00 | not published | 0 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | $3.98 | $7.65 | $5.18 – $5.18 | 1 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | $217.36 | $418.00 | $44.00 – $44.00 | 1 |
| Alpha-fetoprotein amniotic CPT 82106 | $149.24 | $287.00 | $12.00 – $12.00 | 1 |
| Alpha-fetoprotein tumor marker CPT 82105 | $26.00 | $50.00 | $12.00 – $12.00 | 1 |
| Alprostadil for injection HCPCS J0270 | $519.93 | $999.87 | $2.64 – $2.64 | 1 |
| Alprostadil urethral suppos HCPCS J0275 | $150.04 | $288.54 | not published | 0 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $13,182.02 | $25,350.04 | $94.00 – $94.00 | 1 |
| Alt/sgpt CPT 84460 | $21.32 | $41.00 | $3.00 – $3.00 | 1 |
| Altuviiio per factor viii iu HCPCS J7214 | $14.21 | $27.32 | $4.67 – $4.67 | 1 |
| Aluminum - quest CPT 82108 | $45.76 | $88.00 | $17.00 – $17.00 | 1 |
| Alveoloplasty each quadrant CPT 41874 | $4,061.20 | $7,810.00 | not published | 0 |
| Alys cplx sp/pn npgt w/prgrm CPT 95972 | $352.04 | $677.00 | not published | 0 |
| Amantadine (symmetrel)-sendout CPT 80375 | $48.88 | $94.00 | $18.00 – $18.00 | 1 |
| Ambl bp mntr w/sw a/r CPT 93788 | $310.44 | $597.00 | not published | 0 |
| Amifostine HCPCS J0207 | $1,740.85 | $3,347.79 | $493.00 – $493.00 | 1 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | $15.60 | $30.00 | $0.62 – $0.62 | 1 |
| Amines vaginal fluid qual CPT 82120 | not published | not published | $3.00 – $3.00 | 1 |
| Amino acid screen, urine CPT 82128 | not published | not published | $10.00 – $10.00 | 1 |
| Amino acid single qual CPT 82127 | not published | not published | $10.00 – $10.00 | 1 |
| Amino acids quant 2-5 CPT 82136 | not published | not published | $13.00 – $13.00 | 1 |
| Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr HCPCS J0281 | $18.05 | $34.72 | $1.49 – $1.49 | 1 |
| Aminolevulinic acid, 10% gel HCPCS J7345 | not published | not published | $1.81 – $1.81 | 1 |
| Aminolevulinic acid delta CPT 82135 | not published | not published | $12.00 – $12.00 | 1 |
| Aminolevulinic acid hcl top HCPCS J7308 | $640.56 | $1,231.85 | $394.00 – $394.00 | 1 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $45.02 | $86.57 | $8.33 – $8.33 | 1 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $89.02 | $171.20 | $2.61 – $2.61 | 1 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $115.44 | $222.00 | $0.51 – $0.51 | 1 |
| Amitriptyline (elavil) -sendout CPT 80335 | $260.00 | $500.00 | $18.00 – $18.00 | 1 |
| Amivantamab-vmjw 50 mg/ml intravenous solution HCPCS J9061 | $6,199.36 | $11,921.85 | $22.00 – $22.00 | 1 |
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.