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 |
|---|---|---|---|---|
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $1,114.40 | $1,990.00 | not published | 0 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $436.80 | $780.00 | not published | 0 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $1,321.60 | $2,360.00 | not published | 0 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $1,422.40 | $2,540.00 | not published | 0 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $537.60 | $960.00 | not published | 0 |
| Ghs sleep study unattended CPT 95800 | $784.00 | $1,400.00 | not published | 0 |
| Ghs somatosensory testing lower extremit CPT 95926 | $1,019.20 | $1,820.00 | not published | 0 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $1,416.80 | $2,530.00 | not published | 0 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $176.96 | $316.00 | not published | 0 |
| Ghs sphenopalatine ganglion block CPT 64505 | $1,887.20 | $3,370.00 | not published | 0 |
| Ghs spont nystagmus CPT 92541 | $392.00 | $700.00 | not published | 0 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $672.00 | $1,200.00 | not published | 0 |
| Ghs st - eval for alt comm CPT 92567 | $232.96 | $416.00 | not published | 0 |
| Ghs strapping shoulder - 29240 CPT 29240 | $358.40 | $640.00 | not published | 0 |
| Ghs st - re-eval for alt comm CPT 92597 | $677.60 | $1,210.00 | not published | 0 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | $548.80 | $980.00 | not published | 0 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | $1,036.00 | $1,850.00 | not published | 0 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $2,497.60 | $4,460.00 | not published | 0 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $2,497.60 | $4,460.00 | not published | 0 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $4,132.80 | $7,380.00 | not published | 0 |
| Ghs trypsin (fecal) CPT 84488 | $90.16 | $161.00 | $6.00 – $6.00 | 1 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $1,215.20 | $2,170.00 | not published | 0 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | $1,125.60 | $2,010.00 | not published | 0 |
| Ghs urine, hydroxproline total CPT 83505 | $246.96 | $441.00 | $22.00 – $22.00 | 1 |
| Ghs urine, porphyrins quant CPT 84120 | $38.08 | $68.00 | $14.00 – $14.00 | 1 |
| Ghs vaginal delivery only CPT 59409 | $10,001.60 | $17,860.00 | not published | 0 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $1,932.00 | $3,450.00 | not published | 0 |
| Ghs windowing of cast CPT 29730 | $918.40 | $1,640.00 | not published | 0 |
| Giardia ag if CPT 87269 | $51.52 | $92.00 | $13.00 – $13.00 | 1 |
| Giardia lamblia antibody CPT 86674 | $83.44 | $149.00 | $14.00 – $14.00 | 1 |
| Gi endoscopic ultrasound CPT 76975 | $1,685.60 | $3,010.00 | $323.00 – $323.00 | 1 |
| Gi inhouse confirmation CPT 87045 | $125.44 | $224.00 | $8.00 – $8.00 | 1 |
| Gingivoplasty each quadrant CPT 41872 | $9,038.40 | $16,140.00 | not published | 0 |
| Gi protein loss CPT 78282 | $2,620.80 | $4,680.00 | $537.00 – $537.00 | 1 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $5,017.60 | $8,960.00 | not published | 0 |
| Gi trc img intral colon i&r CPT 91113 | $2,424.80 | $4,330.00 | not published | 0 |
| Gi trc img intral esophagus CPT 91111 | $3,063.20 | $5,470.00 | not published | 0 |
| Gi wireless capsule measure CPT 91112 | $2,587.20 | $4,620.00 | not published | 0 |
| Gjb2 gene full sequence CPT 81252 | $230.16 | $411.00 | $45.00 – $45.00 | 1 |
| Gjb2 gene known fam variants CPT 81253 | $141.12 | $252.00 | $27.00 – $27.00 | 1 |
| Gjb6 gene com variants CPT 81254 | $106.40 | $190.00 | $16.00 – $16.00 | 1 |
| Glassia injection HCPCS J0257 | $20.32 | $36.28 | $5.71 – $5.71 | 1 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | $206.08 | $368.00 | not published | 0 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | $149.52 | $267.00 | not published | 0 |
| Glaucoma surgery CPT 66150 | $8,814.40 | $15,740.00 | not published | 0 |
| Glaucoma surgery CPT 66155 | $3,141.60 | $5,610.00 | not published | 0 |
| Glaucoma surgery CPT 66160 | $7,184.80 | $12,830.00 | not published | 0 |
| Glaucoma surgery CPT 66170 | $13,305.60 | $23,760.00 | not published | 0 |
| Glove finger flexion right lg xl HCPCS L3912 | $131.60 | $235.00 | not published | 0 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $540.41 | $965.02 | $196.00 – $196.00 | 1 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $491.67 | $877.98 | $145.00 – $145.00 | 1 |
| Glucagon plasma - sendout CPT 82943 | $25.76 | $46.00 | $13.00 – $13.00 | 1 |
| Glucagon tolerance panel CPT 80422 | $459.20 | $820.00 | $43.00 – $43.00 | 1 |
| Glucagon tolerance panel CPT 80424 | $498.40 | $890.00 | $46.00 – $46.00 | 1 |
| Glucagon tolerance test CPT 82946 | $152.88 | $273.00 | $16.00 – $16.00 | 1 |
| Glucose 1 hr post dose CPT 82950 | $26.32 | $47.00 | $5.00 – $5.00 | 1 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | $114.80 | $205.00 | $6.00 – $6.00 | 1 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $73.36 | $131.00 | $3.00 – $3.00 | 1 |
| Glucose blood quantitative CPT 82947 | $37.52 | $67.00 | $3.00 – $3.00 | 1 |
| Glucose body fluid CPT 82945 | $98.56 | $176.00 | $3.00 – $3.00 | 1 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $554.40 | $990.00 | not published | 0 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $137.20 | $245.00 | $11.00 – $11.00 | 1 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $52.64 | $94.00 | $3.00 – $3.00 | 1 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $15.94 | $28.46 | $0.43 – $0.43 | 1 |
| Gold sodium thiomaleate inj HCPCS J1600 | not published | not published | $17.00 – $17.00 | 1 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $12,754.16 | $22,775.29 | $11.00 – $11.00 | 1 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $138.32 | $247.00 | $18.00 – $18.00 | 1 |
| Gonadotropin hormone panel CPT 80426 | $1,394.40 | $2,490.00 | $137.00 – $137.00 | 1 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $182.00 | $325.00 | $18.00 – $18.00 | 1 |
| Gonioscopy CPT 92020 | $135.52 | $242.00 | not published | 0 |
| Goniotomy CPT 65820 | $5,476.80 | $9,780.00 | not published | 0 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $5,638.80 | $10,069.28 | $734.00 – $734.00 | 1 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $3,360.75 | $6,001.34 | not published | 0 |
| Graft axiofill 1000mg HCPCS J3590 | $38,833.55 | $69,345.63 | not published | 0 |
| Graft hand or finger tendon CPT 26416 | $7,968.80 | $14,230.00 | not published | 0 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $15,819.72 | $28,249.50 | not published | 0 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | $3,696.00 | $6,600.00 | not published | 0 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $17,682.00 | $31,575.00 | not published | 0 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $48,300.00 | $86,250.00 | not published | 0 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $10,620.71 | $18,965.55 | not published | 0 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $9,979.20 | $17,820.00 | not published | 0 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $7,140.00 | $12,750.00 | not published | 0 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $5,018.16 | $8,961.00 | not published | 0 |
| Graft tis hmatrix dermis 10x5 -cost per sq cm HCPCS Q4134 | $3,822.00 | $6,825.00 | not published | 0 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $20,022.24 | $35,754.00 | not published | 0 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $4,452.00 | $7,950.00 | not published | 0 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $36,640.80 | $65,430.00 | not published | 0 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $48,300.00 | $86,250.00 | not published | 0 |
| Granisetron 1 mg tab HCPCS Q0166 | $72.80 | $130.00 | $49.00 – $49.00 | 1 |
| Granisetron hcl injection HCPCS J1626 | $48.50 | $86.60 | $0.23 – $0.23 | 1 |
| Granulocyte pheresis ea unit HCPCS P9050 | $1,650.88 | $2,948.00 | not published | 0 |
| Great toe with reduction 28495 CPT 28495 | $1,282.40 | $2,290.00 | not published | 0 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | $8,932.00 | $15,950.00 | not published | 0 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | $11,300.80 | $20,180.00 | not published | 0 |
| Grfg autol fat lipo ea addl CPT 15772 | $4,026.40 | $7,190.00 | not published | 0 |
| Grfg autol soft tiss dir exc CPT 15769 | $11,300.80 | $20,180.00 | not published | 0 |
| Group behave couns 2-10 HCPCS G0473 | $230.72 | $412.00 | not published | 0 |
| Group health education CPT 99078 | $27.44 | $49.00 | not published | 0 |
| Group mnt 2 or more 30 mins HCPCS G0271 | $43.12 | $77.00 | not published | 0 |
| Group train without patient HCPCS G0543 | $47.60 | $85.00 | not published | 0 |
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.