Santa Rosa Memorial Hospital
1165 Montgomery Dr, Santa Rosa, CA · Providence · · NPI 1134152549
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 |
|---|---|---|---|---|
| Trichomonas assay w/optic CPT 87808 | not published | not published | $14.98 – $79.77 | 4 |
| #tricyclicantidprssnt CPT 80337 | $5.56 | $10.91 | $0.07 – $173.12 | 2 |
| Triglycerides CPT 84478 | $143.31 | $281.00 | $5.63 – $50.22 | 4 |
| Trilaciclib 300 mg intravenous solution HCPCS J1448 | not published | not published | $5.38 – $11.59 | 4 |
| Trimethobenzamide hci 250mg HCPCS Q0173 | not published | not published | $1.40 – $1.40 | 1 |
| Trimethobenzamide hcl inj HCPCS J3250 | not published | not published | $6.58 – $107.59 | 3 |
| Trim nail(s) HCPCS G0127 | not published | not published | $82.09 – $1,716.00 | 3 |
| Trim nondyst nails CPT 11719 | $185.64 | $364.00 | $82.09 – $1,716.00 | 4 |
| Triptorelin pamoate HCPCS J3315 | not published | not published | $459.99 – $1,014.00 | 4 |
| Trluml dil aq o/f can without st CPT 66174 | not published | not published | $2,995.00 – $11,377.00 | 5 |
| Trluml dil aq o/f can w/st CPT 66175 | not published | not published | $2,995.00 – $11,377.00 | 5 |
| Trml dstrj ios bvn 1st 2 l/s CPT 64628 | not published | not published | $691.00 – $18,229.15 | 5 |
| Trml dstrj ios bvn ea addl CPT 64629 | not published | not published | $691.00 – $12,908.00 | 4 |
| Trmt of fracture (femoral shaft) 27500 CPT 27500 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Trnscath plc stent crv crtd without prtct CPT 37216 | $11,603.52 | $22,752.00 | $6,732.00 – $19,505.00 | 3 |
| Trnscath plc stent crv crtd w/prtct CPT 37215 | $20,683.05 | $40,555.00 | $6,732.00 – $19,505.00 | 3 |
| Trnscath plc stnt ante carotid art CPT 37218 | $13,634.85 | $26,735.00 | $691.00 – $19,505.00 | 4 |
| Trnscath plc vas stent w/s&i ea addl artery CPT 37237 | not published | not published | $4,042.00 – $15,575.00 | 4 |
| Trnscath plc vas stent w/s&i ea addl vein CPT 37239 | $10,953.27 | $21,477.00 | $4,042.00 – $15,575.00 | 4 |
| Trnscath plc vas stent w/s&i ini vein CPT 37238 | $14,819.58 | $29,058.00 | $4,233.00 – $20,488.00 | 5 |
| Trnscath retrv pq vasc fb w/guide CPT 37197 | $10,032.21 | $19,671.00 | $2,995.00 – $11,377.00 | 5 |
| Trnscath tx thromblytc artery non-intracrn ini day CPT 37211 | $11,174.61 | $21,911.00 | $3,423.00 – $15,575.00 | 5 |
| Trnscath tx thromblytc art/ven sbsq day CPT 37213 | $6,427.02 | $12,602.00 | $2,741.00 – $4,483.19 | 5 |
| Trnscath tx thromblytc cath rmv sbsq day CPT 37214 | $6,427.02 | $12,602.00 | $2,741.00 – $4,483.19 | 5 |
| Trnscath tx thromblytc vein ini day CPT 37212 | $11,174.61 | $21,911.00 | $3,423.00 – $11,377.00 | 5 |
| Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm CPT 14301 | $7,088.49 | $13,899.00 | $3,423.00 – $11,377.00 | 5 |
| Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/< CPT 14302 | $2,413.83 | $4,733.00 | $1,716.00 – $12,908.00 | 4 |
| Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/< CPT 14060 | $3,760.74 | $7,374.00 | $2,870.98 – $5,318.00 | 5 |
| Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm CPT 14061 | $3,760.74 | $7,374.00 | $2,870.98 – $5,318.00 | 5 |
| Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm CPT 14021 | not published | not published | $2,870.98 – $5,318.00 | 5 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm CPT 14001 | not published | not published | $2,870.98 – $5,318.00 | 5 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/< CPT 14000 | not published | not published | $2,870.98 – $4,737.00 | 5 |
| Trnsplj pd lvr&bwl cd154+cll CPT 81560 | not published | not published | $627.92 – $1,281.46 | 3 |
| Trnspl rej kdn mrna qpcr 139 CPT 81558 | not published | not published | $3,175.20 – $6,480.00 | 4 |
| Trnsxj/repos abrrnt rnl vsls CPT 50100 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Troponin quantitative CPT 84484 | $356.49 | $699.00 | $12.22 – $167.45 | 4 |
| Tr retinal les preterm inf CPT 67229 | not published | not published | $765.30 – $5,530.00 | 5 |
| Trurl dstrj prst8 tiss rf wv CPT 53854 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Truskin, per sq centimeter HCPCS Q4167 | not published | not published | $75.49 – $260.19 | 4 |
| Tte w or without contr, cont ecg HCPCS C8930 | not published | not published | $1,090.80 – $2,238.00 | 4 |
| Tte w or without fol w/con,stres HCPCS C8928 | not published | not published | $1,090.80 – $1,726.40 | 3 |
| Tte w or without fol w/cont, com HCPCS C8921 | not published | not published | $1,090.80 – $1,113.06 | 2 |
| Tte w or without fol w/cont, f/u HCPCS C8922 | not published | not published | $1,090.80 – $1,113.06 | 2 |
| Tubal Ligation (Laparoscopic) CPT 58670 | not published | not published | $3,423.00 – $15,575.00 | 5 |
| Tube trach disp innr can 5 xlt HCPCS A7521 | $774.69 | $1,519.00 | not published | 0 |
| Tumor cell deplete of harvst CPT 38211 | not published | not published | $613.88 – $4,042.00 | 5 |
| Tvh >250 gms 58290 CPT 58290 | not published | not published | $2,238.00 – $12,568.00 | 5 |
| Tvh w/mmk 58267 CPT 58267 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Tx atrial fib pulm vein isol CPT 93656 | $26,151.27 | $51,277.00 | $6,682.00 – $36,369.89 | 5 |
| Tx closed distal humerus fx CPT 24999 | not published | not published | $343.23 – $2,238.00 | 4 |
| Tx closed hip disl traumatic without anes CPT 27250 | $1,446.87 | $2,837.00 | $343.23 – $4,042.00 | 5 |
| Tx closed tib fx proximal w/w/o manip w/skel trac CPT 27532 | $5,427.93 | $10,643.00 | $2,238.00 – $4,737.00 | 5 |
| Tx closed tib shaft fx without manip CPT 27750 | $608.94 | $1,194.00 | $343.23 – $4,042.00 | 5 |
| Tx contour defects >10.0 cc CPT 11954 | not published | not published | $691.00 – $4,042.00 | 5 |
| Tx contour defects 1.1-5.0cc 11951 CPT 11951 | not published | not published | $691.00 – $4,042.00 | 5 |
| Tx ectopic pregnancy abdl pregnancy 59130 CPT 59130 | not published | not published | $6,682.00 – $9,773.00 | 3 |
| Tx ectopic pregnancy ntrstl prtl rescj uter 59136 CPT 59136 | not published | not published | $6,682.00 – $12,568.00 | 3 |
| Tx l/r atrial fib addl CPT 93657 | $3,190.05 | $6,255.00 | $1,716.00 – $12,908.00 | 4 |
| Tx open art fx mcp/iphlngl jnt incl int fixtn ea CPT 26746 | $6,447.42 | $12,642.00 | $4,552.87 – $9,773.00 | 5 |
| Tx open dstl phlngl fx f/t internal fixation ea CPT 26765 | $6,249.54 | $12,254.00 | $4,233.00 – $9,773.00 | 5 |
| Tx open iphlngl jt disl internal fixation sngl CPT 26785 | $13,636.89 | $26,739.00 | $2,995.00 – $6,732.00 | 5 |
| Tx open nsl fx uncomp CPT 21325 | $6,161.82 | $12,082.00 | $4,233.00 – $9,773.00 | 5 |
| Tx open nsl sptl fx CPT 21336 | $6,486.18 | $12,718.00 | $4,233.00 – $9,773.00 | 5 |
| Tx phalangeal shaft fx open prox/middle ea CPT 26735 | $6,447.42 | $12,642.00 | $4,233.00 – $9,773.00 | 5 |
| Tx septic abortion surgical 59830 CPT 59830 | not published | not published | $2,995.00 – $15,202.00 | 4 |
| Tx tarsal bone fx without manip 28450 CPT 28450 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Tympanic membrane repair CPT 69610 | not published | not published | $2,158.97 – $6,732.00 | 5 |
| Tympanolysis transcanal 69450 CPT 69450 | not published | not published | $2,238.00 – $11,377.00 | 5 |
| Tympanometry & reflex thresh CPT 92550 | not published | not published | $300.45 – $306.58 | 2 |
| Tympanostomy/ven tube/loc/top anes 69433 CPT 69433 | not published | not published | $750.46 – $4,042.00 | 5 |
| Tympp antrt/mastoidotomy prosthesis torp 69637 CPT 69637 | not published | not published | $6,682.00 – $12,568.00 | 5 |
| Tympp antrt/mastoid without ossic chain recnst 69635 CPT 69635 | not published | not published | $6,682.00 – $12,568.00 | 5 |
| Tyms gene com variants CPT 81346 | not published | not published | $171.31 – $1,097.95 | 4 |
| Typhoid vaccine oral CPT 90690 | not published | not published | $12.80 – $194.04 | 2 |
| U2af1 gene common variants CPT 81357 | not published | not published | $189.38 – $575.51 | 4 |
| Ua w/micro/comp poc CPT 81000 | not published | not published | $3.94 – $27.71 | 4 |
| Ublituximab-xiiy 25 mg/ml intravenous solution HCPCS J2329 | not published | not published | $67.37 – $147.62 | 4 |
| Ugt1a1 gene analy common variants CPT 81350 | not published | not published | $229.32 – $468.00 | 4 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $412.08 | $808.00 | $145.47 – $605.46 | 4 |
| Ultrasound bone density measure CPT 76977 | not published | not published | $53.65 – $209.82 | 4 |
| Ultrasound breast complete CPT 76641 | $599.76 | $1,176.00 | $145.47 – $591.87 | 4 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $599.76 | $1,176.00 | $121.09 – $453.08 | 4 |
| Ultrasound chest CPT 76604 | $1,081.71 | $2,121.00 | $145.47 – $327.93 | 4 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $956.25 | $1,875.00 | $145.47 – $401.73 | 4 |
| Ultrasound dx ophth b-scan CPT 76512 | not published | not published | $145.47 – $385.19 | 4 |
| Ultrasound elastography ea l target les CPT 76983 | not published | not published | $239.23 – $311.09 | 2 |
| Ultrasound elastography parenchyma CPT 76981 | not published | not published | $145.47 – $714.72 | 4 |
| Ultrasound encephalogram CPT 76506 | $1,563.15 | $3,065.00 | $145.47 – $307.90 | 4 |
| Ultrasound exam follow-up CPT 76970 | not published | not published | $262.76 – $262.76 | 1 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $1,298.97 | $2,547.00 | $145.47 – $470.39 | 4 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $1,422.90 | $2,790.00 | $145.47 – $412.72 | 4 |
| Ultrasound guidance for vascular access CPT 76937 | $968.49 | $1,899.00 | $112.50 – $136.99 | 2 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $1,397.91 | $2,741.00 | $382.00 – $1,151.98 | 2 |
| Ultrasound guide intraoperative CPT 76998 | $789.99 | $1,549.00 | $412.79 – $569.89 | 2 |
| Ultrasound guide tissue ablation CPT 76940 | not published | not published | $425.37 – $443.33 | 2 |
| Ultrasound hips infant dynamic CPT 76885 | $1,471.86 | $2,886.00 | $121.09 – $383.65 | 4 |
| Ultrasound infant hips ltd without stress CPT 76886 | $1,471.86 | $2,886.00 | $121.09 – $356.59 | 4 |
| Ultrasound joint complete left CPT 76881 | $1,100.58 | $2,158.00 | $145.47 – $573.56 | 4 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $484.50 | $950.00 | $67.00 – $179.33 | 4 |
| Ultrasound nrv&acc strux 1xtr compre CPT 76883 | not published | not published | $94.13 – $171.01 | 4 |
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.