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 |
|---|---|---|---|---|
| X-ray exam entire spi 6/> vw CPT 72084 | $1,569.27 | $3,077.00 | $145.47 – $583.13 | 4 |
| X-ray exam of arm infant CPT 73092 | $148.92 | $292.00 | $123.85 – $179.33 | 4 |
| X-ray exam of eye sockets CPT 70200 | $1,557.54 | $3,054.00 | $145.47 – $198.36 | 4 |
| X-ray exam of femur 1 CPT 73551 | $557.94 | $1,094.00 | $121.09 – $185.89 | 4 |
| X-ray exam of jaw joint CPT 70328 | $1,538.67 | $3,017.00 | $121.09 – $127.70 | 4 |
| X-ray exam of jaw joint CPT 70332 | not published | not published | $332.01 – $527.77 | 4 |
| X-ray exam of mastoids CPT 70120 | not published | not published | $145.47 – $179.33 | 4 |
| X-ray exam of middle ear CPT 70134 | not published | not published | $186.12 – $770.53 | 4 |
| X-ray exam of penis CPT 74445 | not published | not published | $145.47 – $284.98 | 4 |
| X-ray exam of perineum CPT 74775 | not published | not published | $332.01 – $372.86 | 4 |
| X-ray exam of salivary gland CPT 70380 | not published | not published | $121.09 – $167.51 | 4 |
| X-ray exam of sinuses CPT 70210 | $247.86 | $486.00 | $121.09 – $155.40 | 4 |
| X-ray exam of tear duct CPT 70170 | not published | not published | $236.58 – $372.86 | 4 |
| X-ray exam of teeth CPT 70300 | not published | not published | $60.09 – $127.70 | 4 |
| X-ray exam of teeth CPT 70310 | not published | not published | $106.71 – $372.86 | 4 |
| X-ray exam si joints CPT 72200 | $773.16 | $1,516.00 | $131.05 – $179.33 | 4 |
| X-ray exam thorac spine4/>vw CPT 72074 | $1,786.53 | $3,503.00 | $145.47 – $229.14 | 4 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $444.21 | $871.00 | $106.71 – $127.70 | 4 |
| X-ray facial bones complete > 3 views CPT 70150 | $1,415.76 | $2,776.00 | $145.47 – $197.65 | 4 |
| X-ray fallopian tube CPT 74742 | not published | not published | $393.20 – $786.63 | 2 |
| X-ray femur >=2 views (both sides) CPT 73552 | $976.14 | $1,914.00 | $121.09 – $220.99 | 4 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $678.30 | $1,330.00 | $105.94 – $127.70 | 4 |
| X-ray foot 2 views (both sides) CPT 73620 | $756.33 | $1,483.00 | $121.09 – $127.70 | 4 |
| X-ray forearm 2 views (both sides) CPT 73090 | $926.16 | $1,816.00 | $121.09 – $131.05 | 4 |
| X-ray hand 2 views (both sides) CPT 73120 | $484.50 | $950.00 | $123.85 – $179.33 | 4 |
| X-ray head for orthodontia CPT 70350 | not published | not published | $82.19 – $127.70 | 4 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $1,209.72 | $2,372.00 | $118.88 – $127.70 | 4 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $823.65 | $1,615.00 | $145.47 – $359.78 | 4 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $823.65 | $1,615.00 | $145.47 – $272.80 | 4 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $869.04 | $1,704.00 | $145.47 – $325.45 | 4 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $1,569.27 | $3,077.00 | $145.47 – $391.69 | 4 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $496.74 | $974.00 | $121.09 – $196.23 | 4 |
| X-ray humerus >= 2 views left CPT 73060 | $963.90 | $1,890.00 | $121.09 – $143.23 | 4 |
| X-ray joint survey 1 view CPT 77077 | $159.63 | $313.00 | $145.47 – $279.25 | 4 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $806.82 | $1,582.00 | $121.09 – $131.05 | 4 |
| X-ray knee 3 views (both sides) CPT 73562 | $1,033.26 | $2,026.00 | $121.09 – $143.17 | 4 |
| X-ray knee ap standing bilateral CPT 73565 | $201.96 | $396.00 | $121.09 – $127.70 | 4 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $706.86 | $1,386.00 | $121.09 – $127.70 | 4 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $1,323.45 | $2,595.00 | $145.47 – $224.12 | 4 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $2,267.46 | $4,446.00 | $145.47 – $229.85 | 4 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $2,337.33 | $4,583.00 | $145.47 – $297.15 | 4 |
| X-ray male genital tract CPT 74440 | not published | not published | $283.56 – $372.86 | 4 |
| X-ray mandible complete > 4 views CPT 70110 | $1,611.09 | $3,159.00 | $145.47 – $179.33 | 4 |
| X-ray mandible ltd <4 views CPT 70100 | $1,080.18 | $2,118.00 | $121.09 – $131.00 | 4 |
| X-ray measurement of pelvis CPT 74710 | not published | not published | $264.18 – $264.18 | 1 |
| X-ray nasal bones complete > 3 views CPT 70160 | $1,098.03 | $2,153.00 | $121.09 – $131.05 | 4 |
| X-ray neck soft tissue CPT 70360 | $364.65 | $715.00 | $106.71 – $127.70 | 4 |
| X-ray nose to rectum for foreign body child CPT 76010 | $463.08 | $908.00 | $121.09 – $138.68 | 4 |
| X-ray of mammary ducts CPT 77054 | not published | not published | $332.01 – $919.75 | 4 |
| X-ray optic foramina CPT 70190 | not published | not published | $121.09 – $156.11 | 4 |
| X-ray pelvis 1-2 views CPT 72170 | $819.06 | $1,606.00 | $125.12 – $179.33 | 4 |
| X-ray pelvis complete > 3 views CPT 72190 | $1,098.03 | $2,153.00 | $145.47 – $179.33 | 4 |
| Xray place dist ext thor ao CPT 75959 | not published | not published | $1,169.58 – $1,740.82 | 2 |
| Xray place prox ext thor ao CPT 75958 | $21,218.55 | $41,605.00 | $1,335.49 – $1,988.34 | 2 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $1,005.21 | $1,971.00 | $485.45 – $610.96 | 4 |
| X-ray ribs 2 views left CPT 71100 | $1,210.23 | $2,373.00 | $121.09 – $143.94 | 4 |
| X-ray ribs 3 views bilateral CPT 71110 | $1,765.62 | $3,462.00 | $145.47 – $198.36 | 4 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $1,575.39 | $3,089.00 | $145.47 – $179.33 | 4 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $1,765.62 | $3,462.00 | $145.47 – $224.83 | 4 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $811.41 | $1,591.00 | $145.47 – $179.33 | 4 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $1,050.60 | $2,060.00 | $121.09 – $143.23 | 4 |
| X-ray scapula complete (both sides) CPT 73010 | $1,100.58 | $2,158.00 | $131.05 – $179.33 | 4 |
| X-ray sella turcica CPT 70240 | not published | not published | $106.71 – $127.70 | 4 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $811.41 | $1,591.00 | $113.18 – $127.70 | 4 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $931.26 | $1,826.00 | $121.09 – $197.65 | 4 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $800.70 | $1,570.00 | $249.02 – $770.53 | 4 |
| X-ray skull < 4 views CPT 70250 | $1,039.38 | $2,038.00 | $145.47 – $179.33 | 4 |
| X-ray skull > 4 views complete CPT 70260 | $1,746.24 | $3,424.00 | $145.47 – $225.54 | 4 |
| X-ray slg plne bdy sect without urogr CPT 76100 | not published | not published | $145.47 – $315.76 | 4 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $896.58 | $1,758.00 | $244.06 – $327.22 | 4 |
| X-ray small intestine follow-through study CPT 74248 | $392.70 | $770.00 | $303.94 – $338.41 | 2 |
| X-ray spine single view CPT 72020 | $767.55 | $1,505.00 | $106.71 – $127.70 | 4 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $810.90 | $1,590.00 | $121.09 – $175.43 | 4 |
| X-ray sternum > 2 views CPT 71120 | $975.12 | $1,912.00 | $121.09 – $163.26 | 4 |
| X-ray surgical specimen CPT 76098 | $689.52 | $1,352.00 | $77.45 – $770.53 | 4 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $655.86 | $1,286.00 | $244.06 – $327.93 | 4 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $1,647.81 | $3,231.00 | $121.09 – $209.82 | 4 |
| X-ray thoracic spine 2 views CPT 72070 | $1,186.77 | $2,327.00 | $145.47 – $179.33 | 4 |
| X-ray thoracic spine 3 views CPT 72072 | $1,716.15 | $3,365.00 | $145.47 – $185.53 | 4 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $1,072.53 | $2,103.00 | $121.09 – $168.28 | 4 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $496.74 | $974.00 | $121.09 – $244.92 | 4 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $823.65 | $1,615.00 | $145.47 – $447.52 | 4 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $912.90 | $1,790.00 | $121.09 – $131.05 | 4 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $765.00 | $1,500.00 | $105.94 – $127.70 | 4 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $788.97 | $1,547.00 | $244.06 – $415.26 | 4 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $646.68 | $1,268.00 | $244.06 – $368.05 | 4 |
| X-ray upper gi delay w/kub CPT 74241 | not published | not published | $375.20 – $375.20 | 1 |
| X-ray upper gi&small intest CPT 74245 | not published | not published | $558.49 – $558.49 | 1 |
| X-ray wrist 2 views (both sides) CPT 73100 | $761.94 | $1,494.00 | $121.09 – $127.70 | 4 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | $328.44 | $644.00 | $244.06 – $291.55 | 4 |
| Xtrnl ecg rec>48hr<7d CPT 93241 | not published | not published | $457.55 – $457.55 | 1 |
| Xtrnl ecg rec up to 48 hrs CPT 93224 | not published | not published | $636.63 – $1,407.10 | 2 |
| Xwrap 1 sq cm HCPCS Q4204 | not published | not published | $173.16 – $6,297.39 | 4 |
| Xylose absorption test blood &/or urine CPT 84620 | not published | not published | $12.65 – $103.93 | 4 |
| Xyntha inj HCPCS J7185 | not published | not published | $1.46 – $3.20 | 4 |
| Yersinia antibody CPT 86793 | not published | not published | $12.93 – $115.75 | 4 |
| Yttrium y-90 ibritumomab ther HCPCS A9543 | not published | not published | $55,688.06 – $122,172.78 | 4 |
| Zenith amniotic membrane psc HCPCS Q4253 | not published | not published | $153.73 – $1,359.23 | 4 |
| Ziconotide injection HCPCS J2278 | not published | not published | $9.27 – $20.86 | 4 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | $148.77 | $291.71 | $1.39 – $3.25 | 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.