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 |
|---|---|---|---|---|
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $19,903.74 | $35,542.39 | $42.00 – $42.00 | 1 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | $108,154.36 | $193,132.79 | not published | 0 |
| Lutetium lu 177 vipivotide HCPCS A9607 | $82,549.16 | $147,409.21 | not published | 0 |
| Lvad shower bag heartmate HCPCS Q0501 | $608.16 | $1,086.00 | not published | 0 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | $221.76 | $396.00 | not published | 0 |
| Lwr ext dynamic prosth pylon HCPCS L5985 | $313.60 | $560.00 | not published | 0 |
| Lyme dis dna dir probe CPT 87475 | $203.28 | $363.00 | $19.00 – $19.00 | 1 |
| Lymphatics/lymph node imaging CPT 78195 | $3,393.60 | $6,060.00 | $719.00 – $719.00 | 1 |
| Lymphocyte culture mixed CPT 86821 | $554.40 | $990.00 | $34.00 – $34.00 | 1 |
| Lymphocyte transformation mitogen CPT 86353 | $582.40 | $1,040.00 | $45.00 – $45.00 | 1 |
| Lymphocytotoxicity assay CPT 86805 | $509.60 | $910.00 | $176.00 – $176.00 | 1 |
| Lymphocytotoxicity assay CPT 86806 | $203.28 | $363.00 | $45.00 – $45.00 | 1 |
| Lymph vessel x-ray arm/leg CPT 75801 | $2,564.80 | $4,580.00 | $826.00 – $826.00 | 1 |
| Lymph vessel x-ray arms/legs CPT 75803 | $4,424.00 | $7,900.00 | $2,073.00 – $2,073.00 | 1 |
| Lymph vessel x-ray trunk CPT 75805 | $8,853.60 | $15,810.00 | $4,200.00 – $4,200.00 | 1 |
| Lymph vessel x-ray trunk CPT 75807 | $8,853.60 | $15,810.00 | $4,200.00 – $4,200.00 | 1 |
| Lysis intranasal synechia 30560 CPT 30560 | $2,240.00 | $4,000.00 | not published | 0 |
| Lysis of labial adhesions CPT 56441 | $9,794.40 | $17,490.00 | not published | 0 |
| Lysis penil circumic lesion CPT 54162 | $2,150.40 | $3,840.00 | not published | 0 |
| Lyumjev for insulin pump use HCPCS J1813 | not published | not published | $15.00 – $15.00 | 1 |
| Macro exam dissect molec study ea CPT 88387 | $336.00 | $600.00 | not published | 0 |
| Macroscopic exam arthropod CPT 87168 | $21.84 | $39.00 | $3.00 – $3.00 | 1 |
| Macroscopic exam parasite CPT 87169 | $57.12 | $102.00 | $3.00 – $3.00 | 1 |
| Magnesium CPT 83735 | $120.40 | $215.00 | $6.00 – $6.00 | 1 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $94.08 | $168.00 | $0.50 – $0.50 | 1 |
| Magnetic image bone marrow CPT 77084 | $3,959.20 | $7,070.00 | $525.00 – $525.00 | 1 |
| Makena, 10 mg HCPCS J1726 | $1,405.80 | $2,510.36 | not published | 0 |
| Malaria antibody CPT 86750 | $134.40 | $240.00 | $13.00 – $13.00 | 1 |
| Male sling procedure CPT 53440 | $19,768.00 | $35,300.00 | not published | 0 |
| Mammosite ced HCPCS C1728 | $5,031.60 | $8,985.00 | not published | 0 |
| Manipulate finger w/anesth CPT 26340 | $1,120.00 | $2,000.00 | not published | 0 |
| Manipulate wrist w/anesthes CPT 25259 | $5,700.80 | $10,180.00 | not published | 0 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $256.48 | $458.00 | not published | 0 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $210.00 | $375.00 | not published | 0 |
| Manipulation of hip joint CPT 27275 | $5,700.80 | $10,180.00 | not published | 0 |
| Manipulation of spine CPT 22505 | $5,112.80 | $9,130.00 | not published | 0 |
| Manipulat palm cord post inj CPT 26341 | $1,114.40 | $1,990.00 | not published | 0 |
| Man's shoe oxford brace HCPCS L3225 | $95.20 | $170.00 | not published | 0 |
| Manual diff wbc count b-coat CPT 85009 | $45.36 | $81.00 | $5.00 – $5.00 | 1 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | $733.60 | $1,310.00 | not published | 0 |
| Mapping io sentinel lymph node CPT 38900 | $2,917.60 | $5,210.00 | not published | 0 |
| Map tachycard site(s) CPT 93609 | $2,749.60 | $4,910.00 | not published | 0 |
| Margetuximab-cmkb 25 mg/ml intravenous solution HCPCS J9353 | $5,047.02 | $9,012.53 | $51.00 – $51.00 | 1 |
| Marker biop eviva buckle ss HCPCS A4648 | $50,715.28 | $90,563.00 | not published | 0 |
| Mastectomy form HCPCS L8020 | $235.20 | $420.00 | not published | 0 |
| Mastectomy partial CPT 19301 | $10,376.80 | $18,530.00 | not published | 0 |
| Mast mod rad CPT 19307 | $11,860.80 | $21,180.00 | not published | 0 |
| Mastoidectomy CPT 69501 | $6,406.40 | $11,440.00 | not published | 0 |
| Mastoidectomy complete 69502 CPT 69502 | $14,319.20 | $25,570.00 | not published | 0 |
| Mastoids complete CPT 70130 | $862.40 | $1,540.00 | $142.00 – $142.00 | 1 |
| Mastoid surgery revision CPT 69603 | $14,319.20 | $25,570.00 | not published | 0 |
| Mastopexy CPT 19316 | $8,360.80 | $14,930.00 | not published | 0 |
| Mast simple complete CPT 19303 | $8,853.60 | $15,810.00 | not published | 0 |
| Matrion 1 sq cm HCPCS Q4201 | $16.80 | $30.00 | not published | 0 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $6,876.19 | $12,278.91 | not published | 0 |
| M.avium-intra dna amp prob CPT 87561 | $425.60 | $760.00 | $32.00 – $32.00 | 1 |
| M.avium-intra dna dir prob CPT 87560 | $149.52 | $267.00 | $26.00 – $26.00 | 1 |
| M.avium-intra dna quant CPT 87562 | $431.20 | $770.00 | $40.00 – $40.00 | 1 |
| Maxillofacial fixation CPT 21100 | $11,933.60 | $21,310.00 | not published | 0 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $24.64 | $44.00 | $13.00 – $13.00 | 1 |
| Mayo aathr protein s free CPT 85306 | $123.76 | $221.00 | $14.00 – $14.00 | 1 |
| Mayo activated protein c resistance assay CPT 85307 | $43.68 | $78.00 | $14.00 – $14.00 | 1 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $94.08 | $168.00 | $35.00 – $35.00 | 1 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $16.24 | $29.00 | not published | 0 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $192.08 | $343.00 | $29.00 – $29.00 | 1 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $33.04 | $59.00 | $14.00 – $14.00 | 1 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $80.08 | $143.00 | $29.00 – $29.00 | 1 |
| Mayo alpha 1 antitrypsin CPT 82103 | $24.64 | $44.00 | $13.00 – $13.00 | 1 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $80.08 | $143.00 | $14.00 – $14.00 | 1 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $16.24 | $29.00 | not published | 0 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $80.08 | $143.00 | $29.00 – $29.00 | 1 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $1,657.60 | $2,960.00 | $53.00 – $53.00 | 1 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $593.60 | $1,060.00 | $40.00 – $40.00 | 1 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | $313.60 | $560.00 | $61.00 – $61.00 | 1 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $2,648.80 | $4,730.00 | $508.00 – $508.00 | 1 |
| Mayo androstenedione CPT 82157 | $80.08 | $143.00 | $27.00 – $27.00 | 1 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $24.64 | $44.00 | $13.00 – $13.00 | 1 |
| Mayo antithrombin iii antigen CPT 85301 | $29.68 | $53.00 | $10.00 – $10.00 | 1 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $28.00 | $50.00 | $14.00 – $14.00 | 1 |
| Mayo avwpr vw factor activity CPT 85397 | $128.80 | $230.00 | $29.00 – $29.00 | 1 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | $68.88 | $123.00 | $32.00 – $32.00 | 1 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $134.96 | $241.00 | $29.00 – $29.00 | 1 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $18.48 | $33.00 | $10.00 – $10.00 | 1 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $243.60 | $435.00 | $64.00 – $64.00 | 1 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | $940.80 | $1,680.00 | $94.00 – $94.00 | 1 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $33.60 | $60.00 | $11.00 – $11.00 | 1 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | $80.08 | $143.00 | $29.00 – $29.00 | 1 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $33.60 | $60.00 | $13.00 – $13.00 | 1 |
| Mayo brcmg brucella antibody igm CPT 86622 | $22.40 | $40.00 | $8.00 – $8.00 | 1 |
| Mayo c1 esterase inhibitor CPT 83883 | $61.04 | $109.00 | $13.00 – $13.00 | 1 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $210.56 | $376.00 | $29.00 – $29.00 | 1 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $58.80 | $105.00 | $16.00 – $16.00 | 1 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $107.52 | $192.00 | $26.00 – $26.00 | 1 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | $739.20 | $1,320.00 | $53.00 – $53.00 | 1 |
| Mayo ceruloplasmin CPT 82390 | $79.52 | $142.00 | $10.00 – $10.00 | 1 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $60.48 | $108.00 | $13.00 – $13.00 | 1 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $109.20 | $195.00 | $11.00 – $11.00 | 1 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $33.60 | $60.00 | $11.00 – $11.00 | 1 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $33.60 | $60.00 | $11.00 – $11.00 | 1 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $313.60 | $560.00 | $109.00 – $109.00 | 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.