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 |
|---|---|---|---|---|
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $100.00 | $196.08 | $0.77 – $2.87 | 3 |
| Adenovirus ag ia CPT 87301 | not published | not published | $11.74 – $78.88 | 4 |
| Adenovirus antibody,serum - quest CPT 86603 | $12.16 | $23.85 | $12.61 – $112.97 | 4 |
| Adenovirus assay w/optic CPT 87809 | not published | not published | $21.32 – $81.54 | 4 |
| Adhesiolysis tube ovary 58740 CPT 58740 | not published | not published | $2,238.00 – $24,668.00 | 4 |
| Adh-sendout CPT 84588 | $15.30 | $30.00 | $33.26 – $299.04 | 4 |
| Adj gastric band via subq port CPT 43999 | not published | not published | $1,262.04 – $4,737.00 | 4 |
| Adjmt/revj ext fixj sys anes CPT 20693 | $14,413.11 | $28,261.00 | $3,423.00 – $11,377.00 | 5 |
| Adj tis trans/see area/10.1-30sqcm 14041 CPT 14041 | $3,760.74 | $7,374.00 | $2,870.98 – $5,318.00 | 5 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $101.48 | $198.99 | $0.19 – $1.20 | 2 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $397.29 | $779.00 | $100.19 – $102.23 | 2 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $106.59 | $209.00 | $100.19 – $102.23 | 2 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $748.68 | $1,468.00 | $459.61 – $468.99 | 2 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $614.55 | $1,205.00 | $459.61 – $468.99 | 2 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $69.36 | $136.00 | $100.19 – $102.23 | 2 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $130.56 | $256.00 | $100.19 – $102.23 | 2 |
| Administration immunization 1 vaccine CPT 90471 | $81.60 | $160.00 | $100.19 – $102.23 | 2 |
| Administration immunization each additional vaccine CPT 90472 | $95.88 | $188.00 | not published | 0 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | not published | not published | $100.19 – $102.23 | 2 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | $350.37 | $687.00 | $33.01 – $33.01 | 1 |
| Administration vaccine hepatitis b HCPCS G0010 | not published | not published | $65.16 – $66.49 | 2 |
| Administration vaccine influenza virus HCPCS G0008 | not published | not published | $65.16 – $66.49 | 2 |
| Administration vaccine pneumococcal HCPCS G0009 | not published | not published | $65.16 – $66.49 | 2 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | not published | not published | $28.84 – $28.84 | 1 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | not published | not published | $39.69 – $88.39 | 4 |
| Adrenal cortex & medulla img CPT 78075 | not published | not published | $1,363.20 – $2,035.50 | 4 |
| Adrenalectomy expl w/exc retro tumor 60545 CPT 60545 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Aep hearing status deter i&r CPT 92651 | not published | not published | $300.45 – $306.58 | 2 |
| Aep neurodiagnostic i&r CPT 92653 | not published | not published | $300.45 – $306.58 | 2 |
| Aep thrshld est mlt freq i&r CPT 92652 | not published | not published | $300.45 – $306.58 | 2 |
| Afamelanotide implant, 1 mg HCPCS J7352 | not published | not published | $2,884.55 – $6,177.66 | 4 |
| _afb id by dna probe rflx ast CPT 87149 | $172.89 | $339.00 | $19.65 – $175.84 | 4 |
| #afb mycobacteria suscep. #1 CPT 87190 | not published | not published | $7.16 – $47.39 | 4 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | not published | not published | $113.05 – $856.17 | 4 |
| Aflibercept injection HCPCS J0178 | not published | not published | $717.25 – $1,711.10 | 4 |
| After cataract laser surgery CPT 66821 | not published | not published | $765.30 – $4,042.00 | 5 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | not published | not published | $170.26 – $479.11 | 4 |
| Air conduction bilat CPT 92552 | not published | not published | $185.13 – $188.91 | 2 |
| Air injection into abdomen 49400 CPT 49400 | not published | not published | $1,716.00 – $12,908.00 | 3 |
| Airway resistance by impulse oscillometry 94728 CPT 94728 | not published | not published | $179.04 – $183.64 | 3 |
| Albumin body fluid quantitative each specimen CPT 82042 | $81.60 | $160.00 | $7.62 – $45.38 | 4 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $199.32 | $390.83 | $52.02 – $115.92 | 4 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | not published | not published | $20.81 – $45.64 | 4 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | $172.25 | $337.75 | $52.02 – $119.26 | 4 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | not published | not published | $10.40 – $46.65 | 4 |
| Albumin ischemia modified CPT 82045 | not published | not published | $33.26 – $291.83 | 4 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $160.65 | $315.00 | $5.66 – $50.81 | 4 |
| Albumin serum plasma or whole blood CPT 82040 | $142.29 | $279.00 | $4.85 – $43.49 | 4 |
| Albuterol ipratrop non-comp HCPCS J7620 | $5.61 | $11.00 | $0.39 – $5.19 | 3 |
| Albuterol non-comp con HCPCS J7611 | $5.61 | $11.00 | $0.19 – $0.39 | 3 |
| Albuterol non-comp unit HCPCS J7613 | $5.61 | $11.00 | $0.15 – $0.56 | 3 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | not published | not published | $0.07 – $51.41 | 4 |
| Alcohol/sub misuse assess HCPCS G2011 | not published | not published | $40.25 – $41.07 | 2 |
| Alcohol/subs interv >30 min HCPCS G0397 | not published | not published | $246.98 – $252.02 | 2 |
| Aldesleukin injection HCPCS J9015 | not published | not published | $933.02 – $11,397.71 | 4 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | not published | not published | $2,354.85 – $5,249.20 | 4 |
| Alkaline phosphatase CPT 84075 | $161.16 | $316.00 | $5.08 – $45.38 | 4 |
| Allergen alpha lactalbumin ige CPT 86008 | $2.55 | $5.00 | $17.57 – $139.03 | 4 |
| Allergen egg white ige CPT 86003 | $33.66 | $66.00 | $5.12 – $138.74 | 4 |
| Allergen specific ige qual multi scrn ea CPT 86005 | not published | not published | $7.81 – $142.16 | 4 |
| Allergy injections; 2 or more 95117 CPT 95117 | not published | not published | $65.16 – $66.49 | 2 |
| Allergy injection; single 95115 CPT 95115 | not published | not published | $65.16 – $66.49 | 2 |
| Allergy Skin Testing CPT 95004 | not published | not published | $25.64 – $1,219.29 | 3 |
| Allg patch or app # of tests 95044 CPT 95044 | not published | not published | $52.11 – $1,219.29 | 3 |
| Allgrft implnt knee w/scope CPT 29867 | not published | not published | $8,992.00 – $18,229.15 | 5 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | $8,318.96 | $16,311.68 | $173.16 – $177.93 | 3 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | not published | not published | $173.16 – $219.69 | 3 |
| Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet HCPCS Q4100 | $45,440.26 | $89,098.54 | not published | 0 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $17,726.96 | $34,758.75 | not published | 0 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $48,745.30 | $95,579.01 | $52.61 – $176.69 | 3 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $36,144.57 | $70,871.70 | $173.16 – $691.00 | 4 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $8,834.18 | $17,321.92 | $120.65 – $293.41 | 4 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $12,135.23 | $23,794.56 | not published | 0 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $8,749.36 | $17,155.60 | $173.16 – $276.12 | 3 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $10,064.32 | $19,733.96 | $173.16 – $691.00 | 4 |
| Alloskin HCPCS Q4115 | not published | not published | $26.62 – $176.69 | 3 |
| All tstg perq&iq drugs/biol CPT 95018 | not published | not published | $51.97 – $155.52 | 3 |
| All tstg perq&iq w/venoms CPT 95017 | not published | not published | $40.25 – $61.63 | 3 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | not published | not published | $3.34 – $11.09 | 4 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | $68.85 | $135.00 | $63.12 – $553.00 | 4 |
| Alpha-fetoprotein amniotic CPT 82106 | not published | not published | $16.66 – $147.24 | 4 |
| Alpha-fetoprotein tumor marker CPT 82105 | $196.86 | $386.00 | $16.43 – $147.24 | 4 |
| Alprostadil for injection HCPCS J0270 | $527.72 | $1,034.75 | $1.01 – $18.08 | 2 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $17,531.48 | $34,375.46 | $44.79 – $196.64 | 4 |
| Alt/sgpt CPT 84460 | $174.42 | $342.00 | $5.19 – $45.91 | 4 |
| Altuviiio per factor viii iu HCPCS J7214 | not published | not published | $4.40 – $9.89 | 4 |
| Aluminum - quest CPT 82108 | $6.12 | $12.00 | $24.97 – $223.64 | 4 |
| Alveoloplasty each quadrant CPT 41874 | not published | not published | $4,042.00 – $4,737.00 | 5 |
| Alys cplx sp/pn npgt w/prgrm CPT 95972 | not published | not published | $132.29 – $469.86 | 3 |
| Amantadine (symmetrel)-sendout CPT 80375 | not published | not published | $0.07 – $145.24 | 2 |
| Ambl bp mntr w/sw a/r CPT 93788 | not published | not published | $185.13 – $330.89 | 3 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | $84.15 | $165.00 | $1.20 – $8.53 | 3 |
| Amino acid screen, urine CPT 82128 | not published | not published | $13.59 – $121.66 | 4 |
| Amino acid single qual CPT 82127 | not published | not published | $13.90 – $121.13 | 4 |
| Amino acids quant 2-5 CPT 82136 | not published | not published | $19.22 – $147.36 | 4 |
| Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr HCPCS J0281 | $84.15 | $165.00 | $2.61 – $2.80 | 2 |
| Aminolevulinic acid, 10% gel HCPCS J7345 | not published | not published | $1.74 – $3.83 | 4 |
| Aminolevulinic acid delta CPT 82135 | not published | not published | $16.12 – $144.47 | 4 |
| Aminolevulinic acid hcl top HCPCS J7308 | not published | not published | $140.77 – $847.98 | 4 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $87.59 | $171.74 | $2.87 – $23.76 | 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.