Sierra Nevada Memorial Hospital
155 Glasson Way, Grass Valley, CA · CommonSpirit Health · · NPI 1659361392
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 |
|---|---|---|---|---|
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $174.40 | $320.00 | $4.18 – $85.26 | 12 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $19,255.94 | $35,332.00 | $164.74 – $1,462.16 | 13 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $6,694.24 | $12,283.00 | $1,078.05 – $2,725.00 | 13 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $196.75 | $361.00 | $0.05 – $63.70 | 12 |
| Levetiracetam therapeutic drug level CPT 80177 | $4.36 | $8.00 | $5.36 – $8.00 | 14 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $125.90 | $231.00 | $2.08 – $63.70 | 11 |
| Liberta rc ipg HCPCS C1820 | $49,246.20 | $90,360.00 | $15,429.75 – $60,484.62 | 11 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $171.68 | $315.00 | $31.85 – $63.70 | 7 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $41.97 | $77.00 | $31.85 – $63.70 | 7 |
| Lidocaine therapeutic drug level CPT 80176 | $228.36 | $419.00 | $10.72 – $15.99 | 14 |
| Ligate esophagus veins CPT 43400 | not published | not published | $959.11 – $3,416.89 | 4 |
| Ligate leg veins open CPT 37761 | not published | not published | $478.78 – $4,136.13 | 8 |
| Ligate leg veins radical 37760 CPT 37760 | not published | not published | $484.05 – $4,136.13 | 8 |
| Ligate oviduct(s) add-on 58611 CPT 58611 | not published | not published | $71.16 – $160.82 | 4 |
| Ligate/staple esophagus CPT 43405 | not published | not published | $1,147.52 – $4,088.09 | 4 |
| Ligate/strip long leg vein CPT 37722 | not published | not published | $457.13 – $4,136.13 | 8 |
| Ligate/strip short leg vein CPT 37718 | not published | not published | $388.77 – $4,136.13 | 8 |
| Ligate/transect fallopian tubes 58600 CPT 58600 | not published | not published | $1,086.57 – $4,178.22 | 8 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | not published | not published | $173.45 – $2,129.16 | 8 |
| Ligation common iliac vein CPT 37660 | not published | not published | $683.55 – $2,435.20 | 4 |
| Ligation/divis of long saph vein 37700 CPT 37700 | not published | not published | $232.41 – $4,136.13 | 8 |
| Ligation external carotid artery 37600 CPT 37600 | not published | not published | $427.22 – $4,136.13 | 8 |
| Ligation internal/common carotid artery 37605 CPT 37605 | not published | not published | $427.22 – $4,136.13 | 8 |
| Ligation internal jugular vein 37565 CPT 37565 | not published | not published | $303.32 – $4,136.13 | 8 |
| Ligation major artery chest CPT 37616 | not published | not published | $879.10 – $879.10 | 1 |
| Ligation/major artery/extremity 37618 CPT 37618 | not published | not published | $456.90 – $456.90 | 1 |
| Ligation major artery neck CPT 37615 | not published | not published | $522.57 – $4,136.13 | 6 |
| Ligation nasal sinus artery CPT 30915 | not published | not published | $484.05 – $4,136.13 | 8 |
| Ligation of abdomen artery 37617 CPT 37617 | not published | not published | $886.91 – $3,159.66 | 4 |
| Ligation of femoral vein CPT 37650 | not published | not published | $598.11 – $4,136.13 | 8 |
| Ligation of inf vena cava CPT 37619 | not published | not published | $1,327.62 – $7,103.63 | 8 |
| Ligation of neck artery CPT 37606 | not published | not published | $427.22 – $4,136.13 | 8 |
| Ligation of salivary duct CPT 42665 | not published | not published | $223.01 – $4,261.72 | 8 |
| Ligation of shunt CPT 49428 | not published | not published | $122.61 – $436.84 | 4 |
| Ligation upper jaw artery CPT 30920 | not published | not published | $739.52 – $4,136.13 | 8 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | not published | not published | $216.17 – $4,136.13 | 8 |
| Lig/band angioaccess av fistula CPT 37607 | not published | not published | $312.72 – $4,136.13 | 8 |
| Lig&div&compl strpg saph vn CPT 37735 | not published | not published | $513.09 – $4,136.13 | 8 |
| Limb nerve surgery add-on CPT 64783 | not published | not published | $239.67 – $853.85 | 4 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $53,618.19 | $98,382.00 | $3.68 – $85.26 | 12 |
| Lipase CPT 83690 | $166.23 | $305.00 | $4.17 – $6.22 | 14 |
| Lip exc/transverse wedge/w closure 40510 CPT 40510 | not published | not published | $448.59 – $4,261.72 | 8 |
| Lipoprotein blood high res frac & quant CPT 83701 | $29.78 | $54.64 | $27.02 – $54.64 | 14 |
| Lipoprotein blood quant CPT 83704 | $29.98 | $55.00 | $9.44 – $14.08 | 14 |
| Lipoprotein direct measurement hdl CPT 83718 | $274.14 | $503.00 | $8.19 – $143.08 | 14 |
| Lipoprotein direct measurement ldl CPT 83721 | $251.79 | $462.00 | $4.02 – $6.00 | 14 |
| Lip surgery procedure CPT 40799 | not published | not published | $305.16 – $305.16 | 6 |
| Lithium therapeutic drug level CPT 80178 | $93.20 | $171.00 | $6.61 – $165.62 | 14 |
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | not published | not published | $632.72 – $2,254.08 | 4 |
| Liver Function Test CPT 80076 | $140.61 | $258.00 | $8.17 – $252.84 | 14 |
| Liver hem/re-expl wnd/remove pack 47362 CPT 47362 | not published | not published | $602.82 – $2,147.52 | 4 |
| Liver/spleen imag static only CPT 78215 | $2,348.95 | $4,310.00 | $124.10 – $1,528.80 | 13 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $338.78 – $4,263.74 | 8 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $2.18 | $4.00 | $0.78 – $3.92 | 11 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $69.22 | $127.00 | $1.39 – $63.70 | 12 |
| Low back disk surgery CPT 63030 | not published | not published | $1,281.67 – $9,387.58 | 8 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $4,008.48 | $7,355.00 | $233.94 – $1,657.18 | 13 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $5,291.41 | $9,709.00 | $233.92 – $2,404.92 | 13 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,672.68 | $4,904.00 | $139.74 – $1,215.20 | 13 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $4,107.12 | $7,536.00 | $447.95 – $2,123.66 | 13 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $4,107.12 | $7,536.00 | $380.88 – $7,385.28 | 13 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,684.13 | $4,925.00 | $266.80 – $1,385.72 | 13 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $742.84 | $1,363.00 | $43.45 – $320.46 | 13 |
| Lower jaw bone graft CPT 21215 | not published | not published | $854.44 – $7,773.77 | 8 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $710.90 – $13,681.38 | 8 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $800.08 – $13,681.38 | 8 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $698.74 – $13,681.38 | 8 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $865.95 – $13,681.38 | 8 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $1,710.49 – $24,166.36 | 8 |
| Lumizyme injection HCPCS J0221 | $1,602.30 | $2,940.00 | $219.01 – $2,881.20 | 13 |
| Lung function test (mbc/mvv) CPT 94200 | $195.66 | $359.00 | $18.82 – $351.82 | 13 |
| Lung Function Test (Spirometry) CPT 94010 | $249.61 | $458.00 | $28.23 – $448.84 | 13 |
| Lung perfusion imaging CPT 78580 | $2,100.43 | $3,854.00 | $161.37 – $1,092.70 | 13 |
| Lung transplant double CPT 32853 | not published | not published | $3,064.04 – $10,915.75 | 4 |
| Lung transplant single CPT 32851 | not published | not published | $2,876.27 – $2,876.27 | 1 |
| Lung transplant with bypass CPT 32852 | not published | not published | $2,665.01 – $9,494.21 | 4 |
| Lung transplant with bypass CPT 32854 | not published | not published | $3,236.63 – $11,530.66 | 4 |
| Lung volume reduction 32491 CPT 32491 | not published | not published | $1,010.42 – $2,283.55 | 4 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | $16,484.62 | $30,247.00 | $218.49 – $29,642.06 | 13 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $23,630.66 | $43,359.00 | $44.48 – $14,163.94 | 13 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $12.39 – $44.16 | 8 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | not published | not published | $771.76 – $771.76 | 1 |
| Lymphatics/lymph node imaging CPT 78195 | $2,649.79 | $4,862.00 | $271.89 – $1,437.66 | 13 |
| Lymphocytotoxicity assay CPT 86806 | $177.13 | $325.00 | $47.59 – $318.50 | 14 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $64.51 – $669.21 | 8 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $108.30 – $4,178.22 | 8 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $188.38 – $2,691.95 | 8 |
| Macroscopic exam arthropod CPT 87168 | $76.85 | $141.00 | $3.80 – $28.52 | 14 |
| Macroscopic exam parasite CPT 87169 | $77.94 | $143.00 | $3.12 – $4.65 | 14 |
| Magnesium CPT 83735 | $192.39 | $353.00 | $4.06 – $6.05 | 14 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $388.04 | $712.00 | $0.53 – $63.70 | 12 |
| Male sling procedure CPT 53440 | not published | not published | $854.44 – $17,073.34 | 8 |
| Mammosite ced HCPCS C1728 | $9,018.12 | $16,547.00 | $4,136.75 – $16,216.06 | 11 |
| Management of liver hemorrhage 47361 CPT 47361 | not published | not published | $1,678.56 – $5,979.94 | 4 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $229.34 – $2,103.10 | 8 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $298.21 – $2,103.10 | 8 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $173.86 | $319.00 | $20.84 – $417.00 | 14 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $158.05 | $290.00 | $35.46 – $417.00 | 14 |
| Manipulation of hip joint CPT 27275 | not published | not published | $105.95 – $2,103.10 | 8 |
| Manipulation of spine CPT 22505 | not published | not published | $119.62 – $2,103.10 | 8 |
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.