SIERRA VISTA HOSPITAL, INC.
1010 Murray Ave, San Luis Obispo, CA · Adventisthealth · · NPI 1639101116
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 |
|---|---|---|---|---|
| Smear special stain inclusion bodies/parasites CPT 87207 | $87.30 | $970.00 | $5.99 – $1,105.80 | 11 |
| Smear wet mount CPT 87210 | $69.75 | $775.00 | $5.82 – $12.02 | 11 |
| Sock fracture or equal each HCPCS L3995 | $35.10 | $390.00 | $42.85 – $507.00 | 11 |
| Sodium 24 hour urine CPT 84300 | $19.80 | $220.00 | $5.00 – $162.50 | 11 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $67.41 | $749.00 | $749.00 – $973.70 | 5 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $50.76 | $564.00 | $564.00 – $733.20 | 5 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $39.87 | $443.00 | $32.00 – $41.60 | 5 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $49.41 | $549.00 | $549.00 – $713.70 | 5 |
| Sodium hyaluronate 20 mg/2 ml syringe HCPCS J7321 | $68.67 | $763.00 | $763.00 – $991.90 | 5 |
| Sodium serum/plasma/whole blood CPT 84295 | $41.31 | $459.00 | $4.81 – $596.70 | 11 |
| Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution HCPCS J0209 | $0.36 | $4.00 | $0.88 – $5.20 | 11 |
| Soft interface below knee se HCPCS L2820 | $99.72 | $1,108.00 | $133.05 – $1,440.40 | 11 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $166.68 | $1,852.00 | $479.10 – $2,407.60 | 14 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $13,138.29 | $145,981.00 | $16,116.00 – $20,950.80 | 5 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $141.48 | $1,572.00 | $500.00 – $650.00 | 5 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $2,821.77 | $31,353.00 | $5,043.10 – $6,556.03 | 5 |
| Sterile water/saline, 10 ml HCPCS A4216 | $2.88 | $32.00 | $0.63 – $6.50 | 11 |
| Sterile water/saline, 500 ml HCPCS A4217 | $2.88 | $32.00 | $3.00 – $6.84 | 11 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $133.56 | $1,484.00 | $242.09 – $1,929.20 | 18 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $154.89 | $1,721.00 | $97.89 – $2,109.90 | 18 |
| St evaluation swallow function CPT 92610 | $136.98 | $1,522.00 | $60.32 – $1,575.60 | 18 |
| Strep a ag ia CPT 87430 | $109.80 | $1,220.00 | $16.81 – $58.50 | 11 |
| St treatment speech individual CPT 92507 | $79.47 | $883.00 | $81.24 – $1,008.80 | 18 |
| St treatment swallow dysfunction/oral CPT 92526 | $79.47 | $883.00 | $90.21 – $981.50 | 18 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $20.88 | $232.00 | $232.00 – $301.60 | 5 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $126.63 | $1,407.00 | $1,407.00 – $1,829.10 | 5 |
| Surgical pathology level 1 gross examination only CPT 88300 | $1.25 | $13.86 | $13.86 – $66.84 | 11 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $2.72 | $30.21 | $30.21 – $86.32 | 11 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $3.23 | $35.91 | $35.91 – $120.43 | 11 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $5.40 | $60.00 | $40.47 – $120.43 | 11 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $21.24 | $235.99 | $235.99 – $828.38 | 11 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $29.55 | $328.35 | $328.35 – $1,861.94 | 11 |
| Susceptibility agar dilution per agent CPT 87181 | $25.56 | $284.00 | $4.27 – $369.20 | 11 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $35.01 | $389.00 | $4.75 – $467.58 | 11 |
| Susceptibility mic per plate CPT 87186 | $35.46 | $394.00 | $8.65 – $15.57 | 11 |
| Svc venogram s&i CPT 75827 | $1,003.59 | $11,151.00 | $2,021.06 – $14,496.30 | 11 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $17.91 | $199.00 | $2.85 – $199.00 | 11 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $4,165.29 | $46,281.00 | $46,281.00 – $60,165.30 | 5 |
| T3 (triiodothyronine) free CPT 84481 | $17.73 | $197.00 | $16.94 – $256.10 | 11 |
| T3 (triiodothyronine) total CPT 84480 | $35.28 | $392.00 | $14.18 – $57.20 | 11 |
| T4 (thyroxine) free CPT 84439 | $59.13 | $657.00 | $5.00 – $16.24 | 11 |
| T4 (thyroxine) total CPT 84436 | $106.65 | $1,185.00 | $6.87 – $1,185.00 | 11 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $41.76 | $464.00 | $301.00 – $391.30 | 5 |
| Tacrolimus therapeutic drug level CPT 80197 | $1.53 | $17.00 | $13.73 – $24.71 | 11 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $262.76 | $2,919.60 | $2,335.68 – $5,255.28 | 11 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $0.36 | $4.00 | $0.28 – $5.20 | 11 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $7.83 | $87.00 | $34.00 – $111.56 | 11 |
| Tc-99m diag per dose HCPCS A4641 | $176.04 | $1,956.00 | $1,956.00 – $2,542.80 | 5 |
| Tc-99m disofenin HCPCS A9510 | $146.79 | $1,631.00 | $1,631.00 – $2,120.30 | 5 |
| Tc-99m exametazime diag HCPCS A9521 | $598.95 | $6,655.00 | $927.71 – $8,651.50 | 11 |
| Tc-99m labeled rbc HCPCS A9560 | $28.08 | $312.00 | $312.00 – $405.60 | 5 |
| Tc-99m maa HCPCS A9540 | $23.76 | $264.00 | $264.00 – $343.20 | 5 |
| Tc-99m medronate HCPCS A9503 | $171.27 | $1,903.00 | $1,903.00 – $2,473.90 | 5 |
| Tc-99m mertiatide HCPCS A9562 | $86.76 | $964.00 | $964.00 – $1,253.20 | 5 |
| Tc-99m pentetate dtpa HCPCS A9539 | $41.76 | $464.00 | $464.00 – $603.20 | 5 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $10.08 | $112.00 | $112.00 – $145.60 | 5 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $288.90 | $3,210.00 | $3,210.00 – $4,173.00 | 5 |
| Tc-99m succimer (dmsa) HCPCS A9551 | $284.67 | $3,163.00 | $659.93 – $4,111.90 | 11 |
| Tc-99m sulfur colloid HCPCS A9541 | $63.99 | $711.00 | $711.00 – $924.30 | 5 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $2.70 | $30.00 | $16.50 – $84.56 | 11 |
| T cells absolute cd 4 count CPT 86361 | $1.49 | $16.50 | $16.50 – $48.20 | 11 |
| T cells total count CPT 86359 | $2.70 | $30.00 | $25.00 – $67.91 | 11 |
| Telehealth original site facility fee HCPCS Q3014 | $10.44 | $116.00 | $116.00 – $150.80 | 5 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $45.63 | $507.00 | $172.22 – $659.10 | 11 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $75.87 | $843.00 | $843.00 – $1,095.90 | 5 |
| Test stress cardiovascular tracing only CPT 93017 | $307.08 | $3,412.00 | $277.22 – $4,101.22 | 14 |
| Tetanus immune globulin inj HCPCS J1670 | $181.80 | $2,020.00 | $593.00 – $2,626.00 | 11 |
| Theophylline therapeutic drug level CPT 80198 | $74.88 | $832.00 | $14.14 – $832.00 | 11 |
| Ther nma rdctj intus/obstrcj CPT 74283 | $287.19 | $3,191.00 | $225.20 – $4,148.30 | 11 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $2.88 | $32.00 | $32.00 – $41.60 | 5 |
| Thrombectmy crnry perq mechanical CPT 92973 | $1,031.40 | $11,460.00 | $77.80 – $14,898.00 | 14 |
| Thrombin time CPT 85670 | $2.18 | $24.25 | $5.77 – $27.05 | 11 |
| Thromboplastin inhibition CPT 85705 | $2.18 | $24.25 | $9.63 – $31.53 | 11 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $2.18 | $24.25 | $6.47 – $27.05 | 11 |
| Thyroglobulin antibody CPT 86800 | $0.81 | $9.00 | $3.50 – $28.64 | 11 |
| Thyroid mets imag whole body CPT 78018 | $216.18 | $2,402.00 | $697.12 – $3,122.60 | 11 |
| Thyroid (TSH) Test CPT 84443 | $96.84 | $1,076.00 | $15.95 – $1,398.80 | 11 |
| Thyroid Ultrasound CPT 76536 | $199.80 | $2,220.00 | $134.23 – $2,668.44 | 11 |
| Thyroid uptake measurement CPT 78012 | $273.15 | $3,035.00 | $513.27 – $3,945.50 | 11 |
| Tigecycline injection HCPCS J3243 | $0.99 | $11.00 | $11.00 – $14.30 | 5 |
| Tilt table study CPT 93660 | $417.87 | $4,643.00 | $426.00 – $5,423.60 | 14 |
| Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm HCPCS Q4122 | $28.35 | $315.00 | $144.95 – $409.50 | 11 |
| Tissue transglutaminase iga CPT 86364 | $2.70 | $30.00 | $8.15 – $20.75 | 11 |
| Tl-201 thallium diag per mci HCPCS A9505 | $351.81 | $3,909.00 | $3,909.00 – $5,081.70 | 5 |
| Tlso 2 shl symphys-stern cst HCPCS L0460 | $730.98 | $8,122.00 | $1,204.08 – $10,558.60 | 11 |
| Tlso 3mod sacro-scap pre HCPCS L0462 | $743.13 | $8,257.00 | $1,497.69 – $10,734.10 | 11 |
| Tlso corset front HCPCS L0970 | $59.76 | $664.00 | $175.12 – $863.20 | 11 |
| Tlso rigid frame pre subclav HCPCS L0470 | $622.35 | $6,915.00 | $976.83 – $8,989.50 | 11 |
| Tlso rigid lined custom fab HCPCS L0482 | $1,008.00 | $11,200.00 | $2,120.05 – $14,560.00 | 11 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $17.01 | $189.00 | $189.00 – $245.70 | 5 |
| Tobramycin peak therapeutic drug level CPT 80200 | $79.65 | $885.00 | $16.13 – $1,063.77 | 11 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | $3.15 | $35.00 | $5.71 – $45.50 | 11 |
| Tocilizumab for covid-19 HCPCS Q0249 | $3.06 | $34.00 | $34.00 – $44.20 | 5 |
| Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution HCPCS J9351 | $6.03 | $67.00 | $67.00 – $87.10 | 5 |
| Toxoplasma antibody igg CPT 86777 | $1.01 | $11.25 | $11.25 – $25.90 | 11 |
| Toxoplasma antibody igm CPT 86778 | $1.01 | $11.25 | $11.25 – $25.94 | 11 |
| Transcatheter bx s&i CPT 75970 | $379.44 | $4,216.00 | $4,216.00 – $5,480.80 | 5 |
| Transferrin CPT 84466 | $11.34 | $126.00 | $12.76 – $163.80 | 11 |
| Trauma partial team response w/critical care services level 4 HCPCS G0390 | $3,650.13 | $40,557.00 | $895.00 – $52,724.10 | 13 |
| Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour CPT 94644 | $64.98 | $722.00 | $170.82 – $1,647.00 | 17 |
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.