San Rafael Medical Center
99 MONTECILLO RD, SAN RAFAEL, CA · Kaiserpermanente · · NPI 1194895227
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 |
|---|---|---|---|---|
| Airway resistance by impulse oscillometry 94728 CPT 94728 | $476.00 | $850.00 | not published | 0 |
| Ak 4 bar ling w/hydraul swig HCPCS L5613 | $3,673.60 | $6,560.00 | not published | 0 |
| Ak 4 bar link w/fric swing HCPCS L5611 | $2,228.80 | $3,980.00 | not published | 0 |
| Ak/bk self-aligning unit ea HCPCS L5617 | $618.80 | $1,105.00 | not published | 0 |
| Ak flex inner socket ext fra HCPCS L5651 | $1,352.40 | $2,415.00 | not published | 0 |
| Ak/knee disartic acrylic soc HCPCS L5631 | $495.60 | $885.00 | not published | 0 |
| Ak/knee disartic pelvic band HCPCS L5697 | $120.40 | $215.00 | not published | 0 |
| Ak/knee disartic pelvic join HCPCS L5696 | $280.00 | $500.00 | not published | 0 |
| Ak/knee disartic silesian ba HCPCS L5698 | $156.80 | $280.00 | not published | 0 |
| Ak open end sach HCPCS L5321 | $4,928.00 | $8,800.00 | not published | 0 |
| Ak pelvic control belt light HCPCS L5692 | $201.60 | $360.00 | not published | 0 |
| Ak pelvic control belt pad/l HCPCS L5694 | $274.40 | $490.00 | not published | 0 |
| Ak sleeve susp neoprene/equa HCPCS L5695 | $246.40 | $440.00 | not published | 0 |
| Ak univ multiplex sys frict HCPCS L5616 | $1,587.60 | $2,835.00 | not published | 0 |
| Albumin body fluid quantitative each specimen CPT 82042 | $99.68 | $178.00 | $8.00 – $8.00 | 1 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $210.64 | $376.14 | not published | 0 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | $253.01 | $451.80 | not published | 0 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | $296.32 | $529.15 | not published | 0 |
| Albumin ischemia modified CPT 82045 | $347.20 | $620.00 | $32.00 – $32.00 | 1 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $47.60 | $85.00 | $5.00 – $5.00 | 1 |
| Albumin serum plasma or whole blood CPT 82040 | $45.36 | $81.00 | $5.00 – $5.00 | 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 | $82.32 | $147.00 | $16.00 – $16.00 | 1 |
| Alcohols biomarkers 3/more CPT 80322 | $16.24 | $29.00 | not published | 0 |
| Alcohol/sub misuse assess HCPCS G2011 | $81.76 | $146.00 | not published | 0 |
| Alcohol/subs interv 15-30mn HCPCS G0396 | $238.56 | $426.00 | not published | 0 |
| Alcohol/subs interv >30 min HCPCS G0397 | $442.40 | $790.00 | not published | 0 |
| Aldesleukin injection HCPCS J9015 | $9,724.73 | $17,365.59 | $5,301.00 – $5,301.00 | 1 |
| Aldosterone suppression eval CPT 80408 | $1,187.20 | $2,120.00 | $117.00 – $117.00 | 1 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | $47,974.31 | $85,668.41 | $2,440.00 – $2,440.00 | 1 |
| Alginate dressing <=16 sq in HCPCS A6196 | $11.20 | $20.00 | not published | 0 |
| Alginate drsg >16 <=48 sq in HCPCS A6197 | $43.72 | $78.08 | not published | 0 |
| Alginate drsg wound filler HCPCS A6199 | $15.79 | $28.20 | not published | 0 |
| Alkaline phosphatase CPT 84075 | $36.96 | $66.00 | $5.00 – $5.00 | 1 |
| Allergen alpha lactalbumin ige CPT 86008 | $36.40 | $65.00 | $16.00 – $16.00 | 1 |
| Allergen egg white ige CPT 86003 | $28.00 | $50.00 | $5.00 – $5.00 | 1 |
| Allergen specific ige qual multi scrn ea CPT 86005 | $71.68 | $128.00 | $8.00 – $8.00 | 1 |
| Allergy injections; 2 or more 95117 CPT 95117 | $165.20 | $295.00 | not published | 0 |
| Allergy injection; single 95115 CPT 95115 | $58.24 | $104.00 | not published | 0 |
| Allergy Skin Testing CPT 95004 | $627.20 | $1,120.00 | not published | 0 |
| Allg patch or app # of tests 95044 CPT 95044 | $627.20 | $1,120.00 | not published | 0 |
| Allgrft implnt knee w/scope CPT 29867 | $16,861.60 | $30,110.00 | not published | 0 |
| Allograft 160mg placental salera mini membrane HCPCS Q4168 | $34.72 | $62.00 | not published | 0 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | $5,814.48 | $10,383.00 | not published | 0 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | $4,819.38 | $8,606.04 | not published | 0 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $5,213.60 | $9,310.00 | not published | 0 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $11,781.00 | $21,037.50 | not published | 0 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $5,173.00 | $9,237.50 | not published | 0 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $4,677.40 | $8,352.50 | not published | 0 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $5,488.00 | $9,800.00 | not published | 0 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $4,384.80 | $7,830.00 | not published | 0 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $4,494.00 | $8,025.00 | not published | 0 |
| Alloskin HCPCS Q4115 | $487.20 | $870.00 | not published | 0 |
| All tstg perq&iq drugs/biol CPT 95018 | $159.60 | $285.00 | not published | 0 |
| All tstg perq&iq w/venoms CPT 95017 | $145.60 | $260.00 | not published | 0 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | $4.28 | $7.65 | $5.18 – $5.18 | 1 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | $113.68 | $203.00 | $59.00 – $59.00 | 1 |
| Alpha-fetoprotein amniotic CPT 82106 | $204.40 | $365.00 | $16.00 – $16.00 | 1 |
| Alpha-fetoprotein tumor marker CPT 82105 | $117.04 | $209.00 | $16.00 – $16.00 | 1 |
| Alprostadil for injection HCPCS J0270 | $559.93 | $999.87 | $2.95 – $2.95 | 1 |
| Alprostadil urethral suppos HCPCS J0275 | $161.58 | $288.54 | not published | 0 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $14,196.02 | $25,350.04 | $94.00 – $94.00 | 1 |
| Alt/sgpt CPT 84460 | $43.12 | $77.00 | $5.00 – $5.00 | 1 |
| Altuviiio per factor viii iu HCPCS J7214 | $15.30 | $27.32 | $4.67 – $4.67 | 1 |
| Aluminum - quest CPT 82108 | $66.64 | $119.00 | $24.00 – $24.00 | 1 |
| Alveoloplasty each quadrant CPT 41874 | $3,892.00 | $6,950.00 | not published | 0 |
| Alys cplx sp/pn npgt w/prgrm CPT 95972 | $728.00 | $1,300.00 | not published | 0 |
| Amantadine (symmetrel)-sendout CPT 80375 | $80.08 | $143.00 | $29.00 – $29.00 | 1 |
| Ambl bp mntr w/sw a/r CPT 93788 | $532.00 | $950.00 | not published | 0 |
| Amifostine HCPCS J0207 | $1,874.76 | $3,347.79 | $554.00 – $554.00 | 1 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | $16.80 | $30.00 | $0.62 – $0.62 | 1 |
| Amines vaginal fluid qual CPT 82120 | $38.64 | $69.00 | $5.00 – $5.00 | 1 |
| Amino acid screen, urine CPT 82128 | $169.12 | $302.00 | $13.00 – $13.00 | 1 |
| Amino acid single qual CPT 82127 | $141.12 | $252.00 | $13.00 – $13.00 | 1 |
| Amino acids quant 2-5 CPT 82136 | $55.44 | $99.00 | $18.00 – $18.00 | 1 |
| Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr HCPCS J0281 | $19.44 | $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 | $45.92 | $82.00 | $16.00 – $16.00 | 1 |
| Aminolevulinic acid hcl top HCPCS J7308 | $689.84 | $1,231.85 | $394.00 – $394.00 | 1 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $48.48 | $86.57 | $8.33 – $8.33 | 1 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $95.87 | $171.20 | $2.61 – $2.61 | 1 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $124.32 | $222.00 | $0.51 – $0.51 | 1 |
| Amitriptyline (elavil) -sendout CPT 80335 | $84.56 | $151.00 | $29.00 – $29.00 | 1 |
| Amivantamab-vmjw 50 mg/ml intravenous solution HCPCS J9061 | $6,676.24 | $11,921.85 | $22.00 – $22.00 | 1 |
| Ammonia CPT 82140 | $222.88 | $398.00 | $13.00 – $13.00 | 1 |
| Amnioarmor 1 sq cm HCPCS Q4188 | $16.80 | $30.00 | not published | 0 |
| Amniocentesisdiagnostic 59000 CPT 59000 | $2,150.40 | $3,840.00 | not published | 0 |
| Amniocentesis therapeutic CPT 59001 | $1,820.00 | $3,250.00 | not published | 0 |
| Amniotic fluid scan CPT 82143 | $84.00 | $150.00 | $8.00 – $8.00 | 1 |
| Amobarbital 125 mg inj HCPCS J0300 | $1,283.59 | $2,292.12 | $15.00 – $15.00 | 1 |
| Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 | $7,845.60 | $14,010.00 | not published | 0 |
| Amphetamine confirm urine -sendout CPT 80324 | $80.08 | $143.00 | $29.00 – $29.00 | 1 |
| Amphetamines 5 or more CPT 80326 | $16.24 | $29.00 | not published | 0 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | $103.60 | $185.00 | $34.00 – $34.00 | 1 |
| Amphotericin b lipid complex HCPCS J0287 | $186.26 | $332.60 | $10.00 – $10.00 | 1 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | $558.95 | $998.13 | $23.00 – $23.00 | 1 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $159.72 | $285.21 | $0.49 – $0.49 | 1 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $122.50 | $218.75 | $1.49 – $1.49 | 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.