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 |
|---|---|---|---|---|
| Unlisted resp px dx nuc med CPT 78599 | not published | not published | $556.27 – $589.01 | 3 |
| Unlisted spec derm svc/px CPT 96999 | not published | not published | $279.18 – $284.87 | 2 |
| Unlisted surgical path px CPT 88399 | not published | not published | $72.51 – $98.94 | 3 |
| Unlisted transfusion med px CPT 86999 | not published | not published | $40.25 – $45.98 | 3 |
| Unlisted ultrasound procedure CPT 76999 | $491.13 | $963.00 | $121.09 – $127.70 | 3 |
| Unlisted vasc endoscopy px CPT 37501 | not published | not published | $872.87 – $4,812.00 | 4 |
| Unlstd hematop ret/endo lymp CPT 78199 | not published | not published | $556.27 – $589.01 | 3 |
| Unlstd laps px mat care&dlvr CPT 59898 | not published | not published | $5,530.00 – $11,377.00 | 4 |
| Unlstd laps px sprmatic cord CPT 55559 | not published | not published | $5,530.00 – $11,377.00 | 4 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $8,272.71 | $16,221.00 | $954.98 – $974.47 | 2 |
| Upgrade pm system CPT 33214 | $15,456.57 | $30,307.00 | $5,318.00 – $20,488.00 | 5 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $8,458.35 | $16,585.00 | $485.45 – $5,471.81 | 4 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $5,764.53 | $11,303.00 | $485.45 – $3,337.35 | 4 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $5,238.72 | $10,272.00 | $332.01 – $3,084.52 | 4 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $1,601.91 | $3,141.00 | $1,262.04 – $4,737.00 | 5 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $1,601.91 | $3,141.00 | $1,262.04 – $4,737.00 | 5 |
| Upper ext harvest for cabg1 seg 35600 CPT 35600 | not published | not published | $2,238.00 – $6,732.00 | 3 |
| Uppr gi scope w/submuc inj CPT 43236 | not published | not published | $1,262.04 – $4,737.00 | 5 |
| Urachal cyst/sinus excision 51500 CPT 51500 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Urea nitrogen CPT 84520 | $142.29 | $279.00 | $3.87 – $34.62 | 4 |
| Urea nitrogen 24 hour urine CPT 84540 | $170.85 | $335.00 | $5.45 – $41.66 | 4 |
| Urea nitrogen clearance CPT 84545 | $346.80 | $680.00 | $7.06 – $57.91 | 4 |
| Urea nitrogen semi-quant CPT 84525 | not published | not published | $5.03 – $32.97 | 4 |
| Ureteral embolization/occl CPT 50705 | not published | not published | $1,716.00 – $12,908.00 | 3 |
| Ureteral reflux study CPT 78740 | not published | not published | $532.79 – $589.01 | 4 |
| Ureter endoscopy CPT 50970 | not published | not published | $2,238.00 – $5,004.98 | 5 |
| Ureter endoscopy & biopsy CPT 50955 | not published | not published | $2,238.00 – $7,613.01 | 5 |
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $2,238.00 – $7,613.01 | 5 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $2,238.00 – $5,004.98 | 5 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $2,238.00 – $7,613.01 | 5 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $2,238.00 – $7,613.01 | 5 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $2,238.00 – $7,613.01 | 5 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $2,238.00 – $7,613.01 | 5 |
| Ureteroneocystostomy 50780 CPT 50780 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Ureteroureterostomy 50760 CPT 50760 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $800.70 | $1,570.00 | $332.01 – $372.86 | 4 |
| Urethrlys transvag with scope CPT 53500 | not published | not published | $4,904.88 – $11,377.00 | 5 |
| Urethrocystography void s&i CPT 74455 | $2,983.50 | $5,850.00 | $332.01 – $396.24 | 4 |
| Uric acid blood CPT 84550 | $143.31 | $281.00 | $4.43 – $39.71 | 4 |
| Uric acid urine CPT 84560 | $17.85 | $35.00 | $4.98 – $41.66 | 4 |
| Urinalysis glass test CPT 81020 | not published | not published | $4.61 – $32.38 | 4 |
| Urinalysis microscopic only CPT 81015 | $100.47 | $197.00 | $2.99 – $26.65 | 4 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | not published | not published | $2.13 – $18.97 | 4 |
| Urinalysis (with microscopy) CPT 81001 | $138.21 | $271.00 | $3.11 – $26.83 | 4 |
| Urinalysis (without microscopy) CPT 81003 | $73.44 | $144.00 | $2.20 – $19.74 | 4 |
| Urinary bldr retent nuc study CPT 78730 | not published | not published | $409.53 – $465.83 | 2 |
| Urinary reflex study CPT 51792 | not published | not published | $82.09 – $4,042.00 | 5 |
| Urine Culture Test CPT 87086 | $304.98 | $598.00 | $7.91 – $69.84 | 4 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $185.13 – $4,042.00 | 5 |
| Urine pregnancy test CPT 81025 | $139.74 | $274.00 | $8.44 – $44.79 | 4 |
| Urine screen for bacteria CPT 81007 | not published | not published | $20.14 – $59.96 | 4 |
| Urine shunt to intestine CPT 50815 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Urine specimen collect mult HCPCS P9615 | not published | not published | $6.00 – $12,908.00 | 3 |
| Urofollitropin, 75 iu HCPCS J3355 | not published | not published | $113.42 – $127.26 | 2 |
| Urography, antegrade CPT 74425 | $663.51 | $1,301.00 | $325.39 – $610.96 | 4 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $244.06 – $488.29 | 4 |
| Urokinase 250,000 iu inj HCPCS J3365 | not published | not published | $650.08 – $650.08 | 1 |
| Urokinase 5000 iu injection HCPCS J3364 | not published | not published | $79.01 – $79.01 | 1 |
| Use 1st target lesion CPT 76982 | not published | not published | $145.47 – $610.25 | 4 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $5,151.04 | $10,100.07 | $11.39 – $27.54 | 4 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | not published | not published | $155.52 – $327.64 | 2 |
| U/s trtmt, not leiomyomata HCPCS C9734 | not published | not published | $4,042.00 – $18,229.15 | 3 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $148.84 | $291.84 | $193.35 – $347.55 | 2 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | $148.84 | $291.84 | $193.35 – $316.18 | 2 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | $133.72 | $262.20 | $173.69 – $335.19 | 2 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | $89.54 | $175.56 | $116.29 – $188.73 | 2 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | $66.67 | $130.72 | $86.62 – $140.93 | 2 |
| Vaccine dtap < 7 years im CPT 90700 | $111.05 | $217.74 | $27.36 – $76.76 | 2 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $301.07 | $590.33 | $91.99 – $265.72 | 2 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | not published | not published | $70.66 – $329.32 | 2 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | not published | not published | $188.89 – $804.51 | 2 |
| Vaccine dtap-ipv/hib im CPT 90698 | not published | not published | $68.16 – $290.23 | 2 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | not published | not published | $70.94 – $78.56 | 2 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $89.77 | $176.02 | $33.57 – $33.95 | 2 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $255.21 | $500.41 | $86.80 – $155.14 | 2 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | not published | not published | $130.11 – $286.10 | 2 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | not published | not published | $41.45 – $90.99 | 2 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im CPT 90634 | $165.95 | $325.40 | $41.45 – $62.59 | 2 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | not published | not published | $98.67 – $161.57 | 2 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $261.94 | $513.60 | $74.93 – $151.32 | 2 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | $444.65 | $871.87 | $180.99 – $381.75 | 2 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $116.86 | $229.14 | $40.15 – $68.09 | 2 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | not published | not published | $233.14 – $793.31 | 2 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | not published | not published | $178.89 – $226.03 | 2 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | not published | not published | $38.67 – $179.50 | 2 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $244.43 | $479.27 | $74.72 – $179.50 | 2 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | not published | not published | $11.59 – $47.00 | 2 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | not published | not published | $20.31 – $48.05 | 2 |
| Vaccine influenza quadrivalent (iiv4) 0.5ml dose im CPT 90688 | not published | not published | $21.14 – $21.14 | 1 |
| Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im CPT 90694 | not published | not published | $26.52 – $26.52 | 1 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im CPT 90685 | not published | not published | $30.51 – $30.51 | 1 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | $84.15 | $165.00 | $25.13 – $25.13 | 1 |
| Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im CPT 90687 | not published | not published | $12.03 – $12.03 | 1 |
| Vaccine influenza quadrivalent live (laiv4) intranasal CPT 90672 | not published | not published | $30.88 – $65.34 | 2 |
| Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im CPT 90682 | not published | not published | $50.36 – $50.36 | 1 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | $142.45 | $279.31 | $46.28 – $79.23 | 2 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | not published | not published | $5.84 – $23.50 | 2 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $629.24 | $1,233.80 | $274.17 – $552.94 | 2 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | not published | not published | $534.55 – $1,158.09 | 2 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | not published | not published | $202.18 – $443.35 | 2 |
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.