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 |
|---|---|---|---|---|
| Insti hexaminolevulinate hcl HCPCS A9589 | $386.37 | $4,293.00 | $4,293.00 – $5,580.90 | 5 |
| Insulin total CPT 83525 | $1.12 | $12.41 | $6.50 – $20.57 | 11 |
| Integra meshed bil wound mat HCPCS C9363 | $34.65 | $385.00 | $385.00 – $500.50 | 5 |
| Intra-atrial pacing CPT 93610 | $2,655.81 | $29,509.00 | $10,014.00 – $38,361.70 | 11 |
| Intracranial complete study CPT 93886 | $345.96 | $3,844.00 | $306.34 – $4,997.20 | 14 |
| Intracranial limited study CPT 93888 | $163.71 | $1,819.00 | $134.23 – $2,364.70 | 14 |
| Intrapul surf admin endo tube CPT 94610 | $140.58 | $1,562.00 | $273.00 – $2,030.60 | 17 |
| Intrinsic factor antibody CPT 86340 | $0.99 | $11.00 | $11.00 – $27.14 | 11 |
| Ionm in operatng room 15 min CPT 95940 | $36.90 | $410.00 | $27.39 – $2,182.00 | 14 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | $2.97 | $33.00 | $33.00 – $42.90 | 5 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $0.90 | $10.00 | $10.00 – $13.00 | 5 |
| Irinotecan 20 mg/ml intravenous solution (wrapper) HCPCS J9206 | $8.64 | $96.00 | $96.00 – $124.80 | 5 |
| Iron CPT 83540 | $56.07 | $623.00 | $6.47 – $809.90 | 11 |
| Iron binding capacity CPT 83550 | $50.22 | $558.00 | $8.74 – $670.72 | 11 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $1.17 | $13.00 | $13.00 – $16.90 | 5 |
| Irradiation of blood product each unit reference CPT 86945 | $11.25 | $125.00 | $47.95 – $162.50 | 11 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $11.43 | $127.00 | $75.74 – $165.10 | 11 |
| Ivc venogram s&i CPT 75825 | $876.78 | $9,742.00 | $4,053.89 – $12,664.60 | 11 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $98.64 | $1,096.00 | $92.44 – $1,003.60 | 14 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $68.49 | $761.00 | $22.69 – $931.00 | 14 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $72.09 | $801.00 | $60.12 – $931.00 | 14 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $163.44 | $1,816.00 | $273.09 – $2,002.53 | 14 |
| IV inj ra drug dx study CPT 78808 | $71.28 | $792.00 | $513.27 – $1,029.60 | 11 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $20.97 | $233.00 | $8.17 – $302.90 | 11 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $0.36 | $4.00 | $0.38 – $5.20 | 11 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $360.00 | $4,000.00 | $697.12 – $5,200.00 | 11 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $199.08 | $2,212.00 | $134.23 – $2,596.10 | 11 |
| Kit case 4.2mm spinejack HCPCS C1062 | $3,470.49 | $38,561.00 | $38,561.00 – $50,129.30 | 5 |
| Kit hfx iq ipg bundle HCPCS C1822 | $20,768.40 | $230,760.00 | $230,760.00 – $299,988.00 | 5 |
| Kit lead specify 5-6-5 HCPCS C1778 | $4,562.82 | $50,698.00 | $10,832.00 – $14,081.60 | 5 |
| Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set HCPCS C1878 | $619.38 | $6,882.00 | $6,882.00 – $8,946.60 | 5 |
| Knee joint cam lock each joi HCPCS L2415 | $191.16 | $2,124.00 | $145.69 – $2,761.20 | 11 |
| Knee joint drop lock ea jnt HCPCS L2405 | $65.79 | $731.00 | $104.57 – $950.30 | 11 |
| Knee MRI (with and without contrast) CPT 73723 | $1,053.27 | $11,703.00 | $447.92 – $15,213.90 | 11 |
| Knee MRI (with contrast) CPT 73722 | $815.49 | $9,061.00 | $1,006.48 – $11,779.30 | 11 |
| Knee MRI (without contrast) CPT 73721 | $734.67 | $8,163.00 | $306.34 – $10,611.90 | 11 |
| Knee X-ray CPT 73564 | $177.84 | $1,976.00 | $134.23 – $2,568.80 | 11 |
| Kras gene addl variants CPT 81276 | $10.62 | $118.00 | $118.00 – $347.85 | 11 |
| Kras gene variants exon 2 CPT 81275 | $10.62 | $118.00 | $118.00 – $347.85 | 11 |
| Lacer molded to patient mode HCPCS L2330 | $378.81 | $4,209.00 | $601.62 – $5,471.70 | 11 |
| Lactate dehydrogenase (ldh) CPT 83615 | $46.08 | $512.00 | $3.25 – $10.87 | 11 |
| Lactated ringers intravenous solution HCPCS J7120 | $84.87 | $943.00 | $812.00 – $1,055.60 | 5 |
| Lactic acid CPT 83605 | $43.83 | $487.00 | $11.57 – $633.10 | 11 |
| Lactoferrin fecal quant CPT 83631 | $4.50 | $50.00 | $19.63 – $65.00 | 11 |
| Lead capillary CPT 83655 | $0.54 | $6.00 | $6.00 – $21.80 | 11 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $600.75 | $6,675.00 | $6,675.00 – $8,677.50 | 5 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $252.36 | $2,804.00 | $306.34 – $3,508.70 | 14 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $9.00 | $100.00 | $100.00 – $130.00 | 5 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $391.86 | $4,354.00 | $176.45 – $5,660.20 | 11 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $925.65 | $10,285.00 | $1,730.32 – $13,370.50 | 11 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $0.27 | $3.00 | $3.00 – $3.90 | 5 |
| Levetiracetam therapeutic drug level CPT 80177 | $1.40 | $15.50 | $13.25 – $23.85 | 11 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $15.93 | $177.00 | $177.00 – $230.10 | 5 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $3.06 | $34.00 | $34.00 – $44.20 | 5 |
| Liberta rc ipg HCPCS C1820 | $10,075.68 | $111,952.00 | $111,952.00 – $145,537.60 | 5 |
| Limited ankle motion ea jnt HCPCS L2200 | $63.99 | $711.00 | $72.84 – $924.30 | 11 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $23.40 | $260.00 | $260.00 – $338.00 | 5 |
| Lipase CPT 83690 | $53.91 | $599.00 | $6.89 – $237.90 | 11 |
| Lipoprotein blood quant CPT 83704 | $1.80 | $20.00 | $20.00 – $61.54 | 11 |
| Lipoprotein direct measurement hdl CPT 83718 | $26.64 | $296.00 | $8.19 – $384.80 | 11 |
| Lipoprotein direct measurement ldl CPT 83721 | $0.32 | $3.50 | $3.50 – $18.90 | 11 |
| Lithium therapeutic drug level CPT 80178 | $26.37 | $293.00 | $6.61 – $380.90 | 11 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | $16.65 | $185.00 | $176.19 – $317.14 | 11 |
| Liver Function Test CPT 80076 | $4.23 | $47.00 | $8.17 – $53.58 | 11 |
| Liver imaging CPT 78201 | $522.09 | $5,801.00 | $697.12 – $7,541.30 | 11 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $13.14 | $146.00 | $146.00 – $189.80 | 5 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $721.26 | $8,014.00 | $447.92 – $10,418.20 | 11 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $941.04 | $10,456.00 | $134.23 – $13,592.80 | 11 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $1,158.93 | $12,877.00 | $447.92 – $16,740.10 | 11 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $760.23 | $8,447.00 | $447.92 – $10,981.10 | 11 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $821.97 | $9,133.00 | $306.34 – $11,872.90 | 11 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $154.62 | $1,718.00 | $134.23 – $2,065.04 | 11 |
| Lso corset front HCPCS L0972 | $40.68 | $452.00 | $157.68 – $587.60 | 11 |
| Lso flex no ri stays pre ots HCPCS L0628 | $222.75 | $2,475.00 | $28.70 – $3,217.50 | 11 |
| Lso full corset HCPCS L0976 | $178.02 | $1,978.00 | $187.18 – $2,571.40 | 11 |
| Lso r post pnl sj-t9 pre cst HCPCS L0630 | $334.08 | $3,712.00 | $194.26 – $4,825.60 | 11 |
| Lso sag-coronal panel custom HCPCS L0638 | $763.29 | $8,481.00 | $1,582.02 – $11,025.30 | 11 |
| Lso sag-co shell pnl pre ots HCPCS L0651 | $623.61 | $6,929.00 | $406.45 – $9,007.70 | 11 |
| Lso s/c shell/panel custom HCPCS L0640 | $1,048.68 | $11,652.00 | $1,255.19 – $15,147.60 | 11 |
| Lso s/c shell/panel prefab HCPCS L0639 | $690.03 | $7,667.00 | $1,451.22 – $9,967.10 | 11 |
| Lumbar derotation pad HCPCS L1240 | $42.03 | $467.00 | $118.97 – $607.10 | 11 |
| Lung Function Test (Spirometry) CPT 94010 | $93.69 | $1,041.00 | $277.22 – $1,616.00 | 14 |
| Lung perfusion imaging CPT 78580 | $157.14 | $1,746.00 | $513.27 – $2,269.80 | 11 |
| Lymphatics/lymph node imaging CPT 78195 | $203.85 | $2,265.00 | $697.12 – $2,944.50 | 11 |
| Macroscopic exam arthropod CPT 87168 | $18.00 | $200.00 | $4.27 – $260.00 | 11 |
| Macroscopic exam parasite CPT 87169 | $18.18 | $202.00 | $4.31 – $262.60 | 11 |
| Magnesium CPT 83735 | $42.66 | $474.00 | $6.00 – $12.06 | 11 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $2.07 | $23.00 | $12.00 – $15.60 | 5 |
| Makena, 10 mg HCPCS J1726 | $18.81 | $209.00 | $209.00 – $271.70 | 5 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $72.27 | $803.00 | $170.82 – $1,647.00 | 17 |
| Mastectomy form HCPCS L8020 | $440.91 | $4,899.00 | $255.91 – $6,368.70 | 11 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $13.14 | $146.00 | $100.00 – $260.91 | 11 |
| M.avium-intra dna dir prob CPT 87560 | $9.00 | $100.00 | $27.29 – $130.00 | 11 |
| Mayo aathr protein s free CPT 85306 | $3.42 | $38.00 | $15.32 – $27.58 | 11 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $2.43 | $27.00 | $12.00 – $15.60 | 5 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $2.34 | $26.00 | $14.78 – $33.80 | 11 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $3.17 | $35.25 | $35.25 – $45.83 | 5 |
| Mayo alpha 1 antitrypsin CPT 82103 | $5.94 | $66.00 | $6.00 – $24.19 | 11 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $4.05 | $45.00 | $15.08 – $58.50 | 11 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $15.75 | $175.00 | $91.66 – $227.50 | 11 |
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.