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 |
|---|---|---|---|---|
| Detect agent nos dna dir CPT 87797 | not published | not published | $29.43 – $170.29 | 4 |
| Detect agnt mult dna direc CPT 87800 | not published | not published | $42.80 – $175.84 | 4 |
| Determination venous press CPT 93770 | $351.39 | $689.00 | $9.51 – $9.51 | 1 |
| Developmental screen/score/document 96110 CPT 96110 | not published | not published | $413.61 – $413.61 | 1 |
| Devel tst phys/qhp 1st hr CPT 96112 | not published | not published | $179.04 – $182.70 | 2 |
| Device ablt adv novasure HCPCS C1886 | $11,844.95 | $23,225.40 | not published | 0 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $7,854.00 | $15,400.00 | $691.00 – $691.00 | 1 |
| Device intraute mirena HCPCS J7298 | $3,363.57 | $6,595.24 | $1,159.66 – $3,133.75 | 2 |
| Device sut capio slim opn HCPCS C2631 | $2,138.40 | $4,192.94 | not published | 0 |
| Device tiss remov myosure reach HCPCS C1782 | $17,054.40 | $33,440.00 | not published | 0 |
| Dev interrog remote 1/2/mlt CPT 93295 | not published | not published | $397.73 – $424.78 | 2 |
| Devise bowel pouch CPT 44316 | not published | not published | $2,995.00 – $9,773.00 | 3 |
| Devlopment test interpt&rep HCPCS G0451 | not published | not published | $141.36 – $144.24 | 2 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $311.10 | $610.00 | $121.09 – $380.99 | 4 |
| Dexametha opth insert 0.1 mg HCPCS J1096 | not published | not published | $90.70 – $237.96 | 4 |
| Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr HCPCS J1095 | not published | not published | $5.83 – $10.48 | 2 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $57.22 | $112.20 | $0.12 – $0.46 | 3 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $84.15 | $165.00 | $0.19 – $1.85 | 3 |
| Dexamethasone intra implant HCPCS J7312 | not published | not published | $199.72 – $441.27 | 4 |
| Dexamethasone panel CPT 80420 | not published | not published | $158.64 – $540.53 | 4 |
| Dexmedetomidine film, 1 mcg HCPCS J1105 | not published | not published | $1.38 – $1.38 | 1 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $1,016.45 | $1,993.04 | $48.74 – $283.77 | 4 |
| Dextran 40 infusion HCPCS J7100 | $65.33 | $128.10 | $110.79 – $164.79 | 2 |
| Dextran 75 infusion HCPCS J7110 | not published | not published | $107.30 – $107.30 | 1 |
| Dextroamphetamine HCPCS S0160 | not published | not published | $0.29 – $0.29 | 1 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $65.33 | $128.10 | $2.51 – $23.28 | 3 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $65.33 | $128.10 | $1.39 – $13.01 | 2 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $65.33 | $128.10 | $3.64 – $13.26 | 3 |
| Dextrose 5 % IV bolus HCPCS J7070 | $65.33 | $128.10 | $7.28 – $14.28 | 3 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $76.50 | $150.00 | $21.79 – $195.11 | 4 |
| Diabetes (HbA1c) Test CPT 83036 | $142.29 | $279.00 | $9.52 – $85.20 | 4 |
| Diab manage trn ind/group HCPCS G0109 | not published | not published | $16.95 – $17.30 | 2 |
| Diag bronchoscope/catheter CPT 31643 | not published | not published | $2,476.66 – $4,737.00 | 5 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Diagnostic anoscopy CPT 46601 | $451.35 | $885.00 | $621.60 – $4,042.00 | 5 |
| Diagnostic anoscopy & biopsy CPT 46607 | not published | not published | $1,665.08 – $4,737.00 | 5 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $451.35 | $885.00 | $185.13 – $4,042.00 | 5 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $61.20 | $120.00 | $192.86 – $661.43 | 3 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $61.20 | $120.00 | $151.28 – $842.80 | 3 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $535.50 | $1,050.00 | $277.75 – $4,042.00 | 5 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $417.69 | $819.00 | $277.75 – $4,042.00 | 5 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $684.42 | $1,342.00 | $118.38 – $820.01 | 4 |
| Diagnostic Mammogram (one breast) CPT 77065 | $684.42 | $1,342.00 | $111.04 – $640.56 | 4 |
| Diagnostic radio unlisted proc CPT 76499 | $700.23 | $1,373.00 | $121.09 – $127.70 | 3 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $2,531.13 | $4,963.00 | $1,716.00 – $12,908.00 | 4 |
| Dialysis one evaluation CPT 90945 | $1,155.66 | $2,266.00 | $580.61 – $592.45 | 2 |
| Diathermy eg microwave CPT 97024 | not published | not published | $7.56 – $7.71 | 2 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $112.61 | $220.80 | $0.16 – $0.17 | 2 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $85.68 | $168.00 | $4.73 – $12.45 | 3 |
| Dicyclomine injection HCPCS J0500 | not published | not published | $20.03 – $27.65 | 3 |
| Difelikefalin, esrd on dialy HCPCS J0879 | not published | not published | $0.19 – $0.37 | 2 |
| Diffusing capacity CPT 94729 | $908.31 | $1,781.00 | $277.95 – $277.95 | 1 |
| Digital analysis of eeg CPT 95957 | not published | not published | $1,627.97 – $1,627.97 | 1 |
| Digit nerve surgery add-on CPT 64778 | not published | not published | $1,716.00 – $15,202.00 | 4 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $84.15 | $165.00 | $2.50 – $10.49 | 3 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $11,090.02 | $21,745.13 | $904.08 – $10,682.45 | 4 |
| Digoxin total therapeutic drug level CPT 80162 | $415.14 | $814.00 | $13.01 – $116.52 | 4 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | not published | not published | $39.69 – $184.36 | 3 |
| Dilate biliary duct/ampulla CPT 47542 | not published | not published | $1,716.00 – $12,908.00 | 4 |
| Dilate esophagus CPT 43453 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | $1,262.04 – $4,737.00 | 5 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | not published | not published | $4,042.00 – $6,732.00 | 2 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | not published | not published | $4,042.00 – $6,732.00 | 2 |
| Dilate ic vasospasm init CPT 61640 | not published | not published | $6,732.00 – $9,773.00 | 2 |
| Dilate tear duct opening CPT 68801 | not published | not published | $621.60 – $4,042.00 | 5 |
| Dilate urethra stricture CPT 53600 | $811.92 | $1,592.00 | $347.66 – $4,042.00 | 5 |
| Dilate urethra stricture CPT 53601 | not published | not published | $185.13 – $4,042.00 | 5 |
| Dilate urethra stricture CPT 53605 | not published | not published | $2,995.00 – $5,004.98 | 5 |
| Dilate urethra stricture CPT 53621 | not published | not published | $347.66 – $4,042.00 | 5 |
| Dilation/female urethra/initial 53660 CPT 53660 | $315.18 | $618.00 | $179.04 – $4,042.00 | 5 |
| Dilation of anal sphincter CPT 45905 | not published | not published | $1,665.08 – $4,737.00 | 5 |
| Dilation of cervical canal 57800 CPT 57800 | not published | not published | $2,995.00 – $6,732.00 | 5 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $1,665.08 – $4,737.00 | 5 |
| Dilation of salivary duct CPT 42660 | not published | not published | $750.46 – $4,042.00 | 5 |
| Dilation of urethra CPT 53661 | not published | not published | $185.13 – $4,042.00 | 5 |
| Dilation of urethra CPT 53665 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Dilation of vagina CPT 57400 | not published | not published | $2,995.00 – $6,732.00 | 5 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $2,158.97 – $4,737.00 | 5 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | $1,354.56 | $2,656.00 | $970.26 – $4,042.00 | 5 |
| Dilator fascial 10fx20cm HCPCS C2627 | $652.85 | $1,280.10 | not published | 0 |
| Dilat xst trc ndurlgc px CPT 50436 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Dilat xst trc new access rcs CPT 50437 | not published | not published | $4,042.00 – $11,377.00 | 5 |
| Dimecaprol injection HCPCS J0470 | not published | not published | $34.96 – $34.96 | 1 |
| Dimenhydrinate injection HCPCS J1240 | not published | not published | $3.62 – $17.95 | 3 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $1,833.33 | $3,594.77 | $79.57 – $1,536.65 | 4 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | $2.55 | $5.00 | $0.09 – $2.80 | 2 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $84.15 | $165.00 | $1.32 – $2.04 | 3 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | not published | not published | $18.08 – $36.16 | 2 |
| Dipyridamole injection HCPCS J1245 | not published | not published | $7.67 – $33.11 | 3 |
| Dir nsl mucous membrane test CPT 95065 | not published | not published | $51.97 – $59.15 | 3 |
| Disability dlco CPT 94727 | not published | not published | $183.64 – $306.58 | 3 |
| Disaccharidases CPT 82657 | $41.95 | $82.25 | $21.73 – $157.82 | 4 |
| Disarticulation sho sec clsr CPT 23921 | not published | not published | $2,870.98 – $5,318.00 | 5 |
| Disarticulation shoulder CPT 23920 | not published | not published | $2,995.00 – $18,229.15 | 5 |
| Discectomy ant dcmprn cord thoracic 1 ntrspc 63077 CPT 63077 | not published | not published | $3,423.00 – $9,773.00 | 3 |
| Discectomy ant dcmprn cord thoracic ea ntrsp 63078 CPT 63078 | not published | not published | $2,238.00 – $6,732.00 | 3 |
| Discography cerv/thor spine CPT 72285 | not published | not published | $627.84 – $2,750.96 | 4 |
| Dise eval slp do brth flx dx CPT 42975 | not published | not published | $691.00 – $4,042.00 | 5 |
| Dissect brain w/scope CPT 62161 | not published | not published | $2,238.00 – $6,732.00 | 3 |
| Dissolve clot heart vessel CPT 92975 | $7,822.38 | $15,338.00 | $4,042.00 – $6,732.00 | 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.