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 |
|---|---|---|---|---|
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $629.85 | $1,235.00 | $565.65 – $4,042.00 | 5 |
| Dressing change not for burn w/anes 15852 CPT 15852 | $1,258.68 | $2,468.00 | $1,028.39 – $4,042.00 | 5 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | $24,714.20 | $48,459.21 | $17.90 – $176.69 | 4 |
| Drill hole evac+/drg subdural hematoma 61108 CPT 61108 | $2,704.53 | $5,303.00 | $2,238.00 – $9,773.00 | 3 |
| Drill hole implt ventricular cath/device 61107 CPT 61107 | $7,380.21 | $14,471.00 | $2,238.00 – $6,732.00 | 3 |
| Drm agrft f/s/n/h/f/g/m ea CPT 15136 | not published | not published | $1,716.00 – $12,908.00 | 4 |
| Drm agrft t/a/l ea addl CPT 15131 | not published | not published | $1,716.00 – $12,908.00 | 4 |
| Drng appendix abscess open 44900 CPT 44900 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Drng hand tendon sheath 26020 CPT 26020 | $6,447.42 | $12,642.00 | $2,995.00 – $4,737.00 | 5 |
| Drng of eyelid abscess 67700 CPT 67700 | $713.49 | $1,399.00 | $441.66 – $4,042.00 | 5 |
| Drng of finger abscess comp 26011 CPT 26011 | $4,263.60 | $8,360.00 | $2,238.00 – $4,737.00 | 5 |
| Drng of hydrocele 55000 CPT 55000 | not published | not published | $691.00 – $4,042.00 | 5 |
| Drng of mouth lesion 40801 CPT 40801 | $1,160.76 | $2,276.00 | $750.46 – $4,042.00 | 5 |
| Drng of ovarian cyst(s) 58800 CPT 58800 | not published | not published | $3,423.00 – $6,732.00 | 5 |
| Drng of palm multi bursas 26030 CPT 26030 | not published | not published | $2,995.00 – $4,737.00 | 5 |
| Drng of palm single bursa 26025 CPT 26025 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Drng of pelvic abscess transrectal 45000 CPT 45000 | $2,346.00 | $4,600.00 | $1,665.08 – $4,737.00 | 5 |
| Drng of salivary cyst 42409 CPT 42409 | not published | not published | $3,423.00 – $6,732.00 | 5 |
| Drng of scrotum abscess 55100 CPT 55100 | $4,263.60 | $8,360.00 | $2,238.00 – $4,737.00 | 5 |
| Drng open retroperitoneal abscess 49060 CPT 49060 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Drng open subdiaphragmatic/subphrenic absc 49040 CPT 49040 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Drng ovary abscess perqt 58822 CPT 58822 | not published | not published | $2,238.00 – $19,505.00 | 4 |
| Drng peritoneal abscess open 49020 CPT 49020 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Drng salivary gland simple 42300 CPT 42300 | $3,006.96 | $5,896.00 | $2,158.97 – $4,737.00 | 5 |
| Drng salivary gland submax/subling 42310 CPT 42310 | $989.91 | $1,941.00 | $750.46 – $4,042.00 | 5 |
| Dronabinol 2.5mg oral HCPCS Q0167 | not published | not published | $2.95 – $6.49 | 3 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | not published | not published | $7.05 – $18.43 | 3 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $2,796.43 | $5,483.20 | not published | 0 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | $5,187.53 | $10,171.63 | $3.80 – $176.69 | 4 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | $799.47 | $1,567.58 | $4.17 – $176.69 | 4 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | not published | not published | $2.87 – $176.69 | 4 |
| Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm HCPCS A2008 | not published | not published | $173.16 – $193.33 | 3 |
| Drsg wnd hyalomatrix 10x10cm -cost per sq cm HCPCS Q4117 | $11,219.31 | $21,998.64 | $33.58 – $176.69 | 4 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | $46,276.42 | $90,738.07 | $17.90 – $176.69 | 4 |
| Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm HCPCS A2007 | not published | not published | $173.16 – $176.69 | 3 |
| Drug admin & hemodynmic meas CPT 93463 | $87.72 | $172.00 | $1,716.00 – $1,716.00 | 1 |
| Drug assay caffeine CPT 80155 | not published | not published | $37.80 – $77.14 | 4 |
| Drug assay posaconazole CPT 80187 | not published | not published | $26.57 – $80.71 | 4 |
| Drug assay rufinamide CPT 80210 | not published | not published | $26.57 – $80.71 | 4 |
| Drug assay vedolizumab CPT 80280 | not published | not published | $37.80 – $114.87 | 4 |
| Drug assay voriconazole CPT 80285 | $81.09 | $159.00 | $26.57 – $80.71 | 4 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $18.27 – $44.08 | 4 |
| Drug of abuse screen urine CPT 80305 | not published | not published | $12.35 – $97.08 | 4 |
| Drug screening tapentadol CPT 80372 | $5.56 | $10.91 | $0.07 – $163.14 | 2 |
| Drug screen quant tiagabine CPT 80199 | not published | not published | $26.57 – $91.23 | 4 |
| Drug/substance nos 4-6 CPT 80376 | not published | not published | $0.07 – $159.77 | 2 |
| Drug test def 15-21 classes HCPCS G0482 | not published | not published | $194.77 – $1,417.44 | 4 |
| Drug test def 1-7 classes HCPCS G0480 | not published | not published | $112.14 – $682.45 | 4 |
| Drug test def 22+ classes HCPCS G0483 | not published | not published | $241.98 – $1,837.66 | 4 |
| Drug test def 8-14 classes HCPCS G0481 | not published | not published | $153.46 – $1,050.15 | 4 |
| Drug test def simple all cl HCPCS G0659 | not published | not published | $60.90 – $517.84 | 4 |
| Drug test prsmv instrmnt CPT 80306 | not published | not published | $16.80 – $129.46 | 4 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $600.78 | $1,178.00 | $60.90 – $517.78 | 4 |
| Drvvt confirm - quest CPT 85597 | $3.51 | $6.89 | $17.62 – $134.01 | 4 |
| Dstrj extensive retinopathy CPT 67227 | not published | not published | $2,238.00 – $11,377.00 | 5 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | not published | not published | $691.00 – $6,732.00 | 5 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | not published | not published | $565.65 – $4,042.00 | 5 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | not published | not published | $565.65 – $4,042.00 | 5 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $1,028.39 – $4,042.00 | 5 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $1,028.39 – $4,042.00 | 5 |
| Dstry eye lesn,fdr vssl tech HCPCS G0186 | not published | not published | $765.30 – $4,042.00 | 4 |
| Ductogram sgl duct CPT 77053 | $680.85 | $1,335.00 | $332.01 – $660.95 | 4 |
| Duodenal exclusion CPT 48547 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Duodenal motility study CPT 91022 | not published | not published | $167.51 – $1,716.00 | 4 |
| Duplex scan bilateral study 93985 CPT 93985 | $342.21 | $671.00 | $332.01 – $1,467.07 | 3 |
| Duplex scan unilateral study 93986 CPT 93986 | not published | not published | $145.47 – $834.66 | 3 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $498.78 | $978.00 | $145.47 – $901.25 | 3 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | not published | not published | $300.45 – $760.21 | 3 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $2,090.49 | $4,099.00 | $332.01 – $1,250.75 | 3 |
| Duragen 1x1 5ea/bx HCPCS C9354 | $23,223.63 | $45,536.52 | $27.18 – $27.18 | 1 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | not published | not published | $84.42 – $180.32 | 4 |
| Dxa bone density axl vrt fx CPT 77085 | $271.83 | $533.00 | $145.47 – $495.39 | 4 |
| Dx aly aud oi snd prcsr 1st CPT 92622 | not published | not published | $179.04 – $691.00 | 3 |
| Dx aly aud oi snd prcsr each CPT 92623 | not published | not published | $691.00 – $691.00 | 1 |
| Dx bronchoscope/brush 31623 CPT 31623 | not published | not published | $2,476.66 – $4,737.00 | 5 |
| Dx bronchoscope/lavage 31624 CPT 31624 | $6,670.80 | $13,080.00 | $2,476.66 – $4,737.00 | 5 |
| Dx bronchoscope/wash 31622 CPT 31622 | $5,221.38 | $10,238.00 | $2,238.00 – $4,737.00 | 5 |
| Dx dark adaptation exam i&r CPT 92284 | not published | not published | $47.57 – $634.29 | 3 |
| Dx duod intub w/asp spec 43756 CPT 43756 | not published | not published | $691.00 – $4,737.00 | 5 |
| Dx duod intub w/asp specs CPT 43757 | not published | not published | $691.00 – $4,737.00 | 5 |
| Dx gastr intub w/asp spec CPT 43754 | $606.39 | $1,189.00 | $300.45 – $4,042.00 | 5 |
| Dx gastr intub w/asp specs CPT 43755 | $315.18 | $618.00 | $179.04 – $4,042.00 | 5 |
| Dx intraop epcar Ultrasound chd i&r CPT 76989 | not published | not published | $198.65 – $223.84 | 2 |
| Dx intraop epicar car Ultrasound chd CPT 76987 | not published | not published | $533.67 – $602.50 | 2 |
| Dx intraop thoracic aorta Ultrasound CPT 76984 | not published | not published | $172.30 – $194.76 | 2 |
| Dx laryngoscopy newborn CPT 31520 | $1,127.61 | $2,211.00 | $544.23 – $4,042.00 | 5 |
| Dx laryngoscopy w/oper scope CPT 31526 | $4,780.74 | $9,374.00 | $2,476.66 – $4,737.00 | 5 |
| Dx ntrop epcr Ultrasound chd img acq CPT 76988 | not published | not published | $339.04 – $382.33 | 2 |
| Dynamic cavernosometry CPT 54231 | not published | not published | $347.66 – $4,737.00 | 4 |
| Dynamic fine wire emg CPT 96003 | not published | not published | $133.18 – $133.18 | 1 |
| Dynamic surface emg CPT 96002 | not published | not published | $143.94 – $306.58 | 3 |
| Ear and throat examination CPT 92502 | not published | not published | $750.46 – $4,042.00 | 4 |
| Ear canal biopsy 69105 CPT 69105 | not published | not published | $2,158.97 – $4,737.00 | 5 |
| Ear cartilage graft CPT 21235 | not published | not published | $4,737.00 – $8,405.34 | 5 |
| Ear irrigation 69209 CPT 69209 | $261.63 | $513.00 | $82.09 – $1,716.00 | 4 |
| Ecallantide injection HCPCS J1290 | not published | not published | $379.20 – $1,213.98 | 4 |
| Ecg 12 lead tracing only CPT 93005 | $156.57 | $307.00 | $66.10 – $135.66 | 3 |
| Ecg/1-3 leads/interp & report only 93042 CPT 93042 | not published | not published | $43.30 – $130.29 | 2 |
| Ecg/1-3 leads/tracing only 93041 CPT 93041 | not published | not published | $34.61 – $82.09 | 3 |
| Ecg < 30 days transmission & analysis CPT 93271 | not published | not published | $132.29 – $1,572.54 | 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.