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 |
|---|---|---|---|---|
| Clsd tx clav dislc without manip 23520 CPT 23520 | $3,107.43 | $6,093.00 | $2,237.46 – $4,737.00 | 5 |
| Clsd tx clavicle dislocation without manip 23540 CPT 23540 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx clavicle fracture w/manip 23505 CPT 23505 | $6,597.36 | $12,936.00 | $2,237.46 – $4,042.00 | 5 |
| Clsd tx/clavicular fx without manip 23500 CPT 23500 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx coccygeal fracture 27200 CPT 27200 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx/dis phalan fx without manip/ea 26750 CPT 26750 | $847.62 | $1,662.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx dist fib fx w/manip 27788 CPT 27788 | $1,022.04 | $2,004.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx/dis tib/wt bear no manip 27824 CPT 27824 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $1,066.92 | $2,092.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx/fem shaft fx/manipulation 27502 CPT 27502 | $3,017.67 | $5,917.00 | $2,237.46 – $4,737.00 | 5 |
| Clsd tx finger tendon w/wo perq pin 26432 CPT 26432 | $3,107.43 | $6,093.00 | $2,237.46 – $5,318.00 | 5 |
| Clsd tx fracture of radius 25500 CPT 25500 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx/fx grt toe/phalanx/phalang 28490 CPT 28490 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx/fx/phalanx/phalang/manip 28515 CPT 28515 | $625.26 | $1,226.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx fx radius/ulna dist without manip 25600 CPT 25600 | $771.12 | $1,512.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $2,350.59 | $4,609.00 | $2,237.46 – $4,042.00 | 5 |
| Clsd tx fx radius/ulna without manip 25560 CPT 25560 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx fx radius/ulna w/manip 25565 CPT 25565 | $1,958.40 | $3,840.00 | $1,716.00 – $4,042.00 | 5 |
| Clsd tx/grt hum tube fx without manip 23620 CPT 23620 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx hip disloc without anes 27265 CPT 27265 | $1,611.09 | $3,159.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx humeral fract without manip 24530 CPT 24530 | $448.29 | $879.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx humerus fract without manip 24500 CPT 24500 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx iphal jnt disl w/manip req anes CPT 26775 | $1,066.92 | $2,092.00 | $389.18 – $4,042.00 | 5 |
| Clsd tx mandibular fx without manip 21450 CPT 21450 | $989.91 | $1,941.00 | $750.46 – $5,318.00 | 5 |
| Clsd tx/metacar/interphal artic fx 26740 CPT 26740 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx/metacarpal fx/sg without manip 26600 CPT 26600 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $847.62 | $1,662.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx metacarp fx w/manip&ext fix ea bone 26607 CPT 26607 | $6,447.42 | $12,642.00 | $2,995.00 – $4,737.00 | 5 |
| Clsd tx metatarsal fracture w/manip 28475 CPT 28475 | $625.26 | $1,226.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx/metatarsal fx without manip 28470 CPT 28470 | $455.94 | $894.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx/nasal bone fx/stabilize 21320 CPT 21320 | $4,769.52 | $9,352.00 | $2,995.00 – $4,737.00 | 5 |
| Clsd tx nose fx without manip 21310 CPT 21310 | not published | not published | $1,333.00 – $4,042.00 | 2 |
| Clsd tx of ankle fracture w/manip 28435 CPT 28435 | $2,734.11 | $5,361.00 | $2,237.46 – $4,737.00 | 5 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $1,096.50 | $2,150.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx/patellar fx without manip 27520 CPT 27520 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx pelvic ring fx CPT 27197 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx pelvic ring fx CPT 27198 | $483.48 | $948.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx prox fib/shaft fx w/manip 27781 CPT 27781 | $2,734.11 | $5,361.00 | $2,237.46 – $4,042.00 | 5 |
| Clsd tx/prox/mid phalnx fx/no manp 26720 CPT 26720 | $724.20 | $1,420.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx/radial head/neck fx/no manip 24650 CPT 24650 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx radius fracture w/manip 24655 CPT 24655 | $1,958.40 | $3,840.00 | $1,716.00 – $4,042.00 | 5 |
| Clsd tx/scapular fx without manip 23570 CPT 23570 | $564.57 | $1,107.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx shoulder dislc/fx 23665 CPT 23665 | $1,958.40 | $3,840.00 | $2,237.46 – $4,042.00 | 5 |
| Clsd tx shoulder disloc w/anatom neck fx w/manip 23675 CPT 23675 | $2,734.11 | $5,361.00 | $1,716.00 – $4,042.00 | 5 |
| Clsd tx/shoulder dislo/manip/anest 23655 CPT 23655 | $3,469.53 | $6,803.00 | $2,237.46 – $4,737.00 | 5 |
| Clsd tx/talotarsal dislocat/anes 28575 CPT 28575 | $6,447.42 | $12,642.00 | $2,238.00 – $4,737.00 | 5 |
| Clsd tx temporomandibular dislocat 21480 CPT 21480 | $1,066.92 | $2,092.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx toe dislocation without anes28660 CPT 28660 | $659.94 | $1,294.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx trimall ankle fx without manip 27816 CPT 27816 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx trimall ankle fx w/manip 27818 CPT 27818 | $1,958.40 | $3,840.00 | $2,237.46 – $4,042.00 | 5 |
| Clsd tx/ulnar shaft fx without manip 25530 CPT 25530 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx vert body fx without manip req &w/csting/bracing CPT 22310 | $451.35 | $885.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx wrist carpal fx without manip 25630 CPT 25630 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx wrist scaphoid fx without manip 25622 CPT 25622 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx wrist trans-scaph fx w/manip 25680 CPT 25680 | $455.94 | $894.00 | $343.23 – $4,042.00 | 5 |
| Clsd tx wrist ulnar styloid fx 25650 CPT 25650 | $820.59 | $1,609.00 | $343.23 – $4,042.00 | 5 |
| Clsd/ulnar fx/prox end without manip 24670 CPT 24670 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Cls tx of heel fracture w/manip 28405 CPT 28405 | $4,323.78 | $8,478.00 | $343.23 – $4,042.00 | 5 |
| Cltx carpl scphd fx w/mnpj CPT 25624 | $1,958.40 | $3,840.00 | $2,237.46 – $4,042.00 | 5 |
| Cltx gr hmrl tbrs fx w/mnpj CPT 23625 | $3,107.43 | $6,093.00 | $2,237.46 – $4,737.00 | 5 |
| Cltx hum epcndylr fx wo mnpj CPT 24560 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Cltx humrl cndylr fx w/mnpj CPT 24577 | $3,107.43 | $6,093.00 | $1,716.00 – $4,042.00 | 5 |
| Cltx humrl cndylr fx wo mnpj CPT 24576 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Cltx lunate dislc w/mnpj CPT 25690 | $4,232.49 | $8,299.00 | $2,237.46 – $4,737.00 | 5 |
| Cltx mndblr fx ntrdntl fixj CPT 21453 | $11,565.78 | $22,678.00 | $3,423.00 – $11,377.00 | 5 |
| Cltx mndblr fx w/mnpj CPT 21451 | $3,006.96 | $5,896.00 | $2,158.97 – $9,773.00 | 5 |
| Cltx mndblr/max alv ridge fx CPT 21440 | $6,199.05 | $12,155.00 | $3,423.00 – $6,732.00 | 5 |
| Cltx palatal/max fx wire fix CPT 21421 | $6,199.05 | $12,155.00 | $4,233.00 – $9,773.00 | 5 |
| Cltx post ankle fx CPT 27767 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Cltx post ankle fx w/mnpj CPT 27768 | $3,107.43 | $6,093.00 | $1,716.00 – $4,042.00 | 5 |
| Cltx scap fx w/mnpj +-tractj CPT 23575 | $3,107.43 | $6,093.00 | $1,716.00 – $4,042.00 | 5 |
| Cltx strnclav dislc w/mnpj CPT 23525 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Cltx thigh fx CPT 27267 | $6,486.18 | $12,718.00 | $2,995.00 – $4,737.00 | 5 |
| Cltx tmprmand dislc comp CPT 21485 | not published | not published | $2,158.97 – $4,737.00 | 5 |
| Cmbn ant pst colprhy CPT 57260 | not published | not published | $4,812.00 – $11,377.00 | 5 |
| C motor evoked lwr limbs CPT 95929 | not published | not published | $519.24 – $804.88 | 3 |
| C motor evoked uppr limbs CPT 95928 | not published | not published | $742.43 – $1,219.29 | 3 |
| C motor evoked upr&lwr limbs CPT 95939 | not published | not published | $1,194.91 – $2,159.04 | 3 |
| Cmptr ophth dx img ant segmt CPT 92132 | not published | not published | $82.09 – $691.00 | 3 |
| Cmptr ophth img optic nerve CPT 92133 | not published | not published | $82.09 – $691.00 | 3 |
| #cms hgb-carboxyhemoglobin CPT 82376 | not published | not published | $13.79 – $52.59 | 4 |
| #cms hgb-sulfhemoglobin CPT 83060 | not published | not published | $8.62 – $72.56 | 4 |
| #cmvcul-virus inoculation shell CPT 87254 | $137.41 | $269.44 | $19.17 – $42.90 | 4 |
| Cmv pcr-sendout CPT 87496 | $147.90 | $290.00 | $34.39 – $298.03 | 4 |
| Co2 monitor per day CPT 94681 | not published | not published | $371.01 – $529.83 | 3 |
| Coagulation factor viia 1,000 mcg/ml inj 1 ml HCPCS J7189 | $26,155.60 | $51,285.49 | $1.85 – $5.44 | 4 |
| Coagulation time activated teg CPT 85347 | $307.02 | $602.00 | $4.19 – $37.34 | 4 |
| Coagulation time otr method CPT 85348 | not published | not published | $4.40 – $31.61 | 4 |
| Cocaine 4 % nasal solution HCPCS C9046 | $858.19 | $1,682.73 | $1.97 – $1.97 | 1 |
| Cochlear implt f/up exam <7 CPT 92601 | not published | not published | $179.04 – $182.70 | 2 |
| Cochlear implt f/up exam 7/> CPT 92603 | not published | not published | $179.04 – $182.70 | 2 |
| Codeine 15 mg/ml inj 2 ml HCPCS J0745 | not published | not published | $1.21 – $2.09 | 2 |
| Cold agglutinin screen (arc) CPT 86156 | not published | not published | $7.91 – $58.32 | 4 |
| Cold agglutinin titer CPT 86157 | $12.48 | $24.47 | $7.90 – $70.79 | 4 |
| Colectomy/end colost/close dis seg 44143 CPT 44143 | not published | not published | $2,995.00 – $9,773.00 | 3 |
| Colectomy/ ileostomy without prctect 44150 CPT 44150 | not published | not published | $2,995.00 – $12,568.00 | 3 |
| Colectomy/ ileostomy w/prctect 44155 CPT 44155 | not published | not published | $3,423.00 – $12,568.00 | 3 |
| Colectomy partial w/anastomosis 44140 CPT 44140 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Colectomy prtl abdominal + transanal appr 44147 CPT 44147 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Colectomy prtl w/coloproctostomy 44145 CPT 44145 | not published | not published | $2,238.00 – $9,773.00 | 3 |
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.