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 |
|---|---|---|---|---|
| ER Visit (level 1, minor) CPT 99281 | $502.86 | $986.00 | $117.33 – $119.73 | 2 |
| ER Visit (level 2) CPT 99282 | $1,014.90 | $1,990.00 | $213.65 – $218.01 | 2 |
| ER Visit (level 3) CPT 99283 | $1,666.17 | $3,267.00 | $379.84 – $387.59 | 2 |
| ER Visit (level 4) CPT 99284 | $2,822.34 | $5,534.00 | $580.61 – $592.45 | 2 |
| ER Visit (level 5, high severity) CPT 99285 | $4,132.02 | $8,102.00 | $828.66 – $845.57 | 2 |
| Erwinaze injection HCPCS J9019 | not published | not published | $455.24 – $1,039.96 | 2 |
| Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1364 | $260.24 | $510.28 | $4.64 – $141.81 | 3 |
| Escharotomy ea addl incision CPT 16036 | $808.35 | $1,585.00 | $2,238.00 – $4,737.00 | 3 |
| Esd endoscopy or colonoscopy HCPCS C9779 | not published | not published | $5,364.75 – $6,732.00 | 3 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) in sterile water intravenous soln HCPCS J1806 | $376.13 | $737.50 | $0.56 – $0.88 | 3 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only HCPCS J1805 | $261.89 | $513.50 | $0.56 – $0.83 | 3 |
| Esophageal dilat s&i CPT 74360 | not published | not published | $631.59 – $786.51 | 2 |
| Esophageal lengthening add on code 43338 CPT 43338 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Esophageal motility CPT 78258 | not published | not published | $556.27 – $724.17 | 4 |
| Esophageal recording CPT 93615 | not published | not published | $1,694.16 – $4,737.00 | 4 |
| Esophageal recording CPT 93616 | not published | not published | $1,694.16 – $4,737.00 | 4 |
| Esophag muc integ w/eso egd HCPCS C9777 | not published | not published | $5,364.75 – $6,732.00 | 3 |
| Esophagomyotomy abdominal 43330 CPT 43330 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Esophagomyotomy thoracic 43331 CPT 43331 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Esophagoplasty congenital CPT 43313 | not published | not published | $4,812.00 – $12,568.00 | 3 |
| Esophagosc dilate balloon 30 CPT 43214 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagosc flex trnsn biopsy CPT 43198 | not published | not published | $1,262.04 – $4,737.00 | 5 |
| Esophagoscop mucosal resect CPT 43211 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagoscop stent placement CPT 43212 | not published | not published | $2,238.00 – $11,377.00 | 5 |
| Esophagoscop ultrasound exam CPT 43231 | not published | not published | $2,670.09 – $4,737.00 | 5 |
| Esophagoscopy balloon <30mm CPT 43220 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagoscopy control bleed CPT 43227 | not published | not published | $2,670.09 – $4,737.00 | 5 |
| Esophagoscopy flex biopsy CPT 43202 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagoscopy/flex/diagnostic 43200 CPT 43200 | $1,601.91 | $3,141.00 | $1,262.04 – $4,737.00 | 5 |
| Esophagoscopy flex dx brush CPT 43197 | not published | not published | $1,262.04 – $4,737.00 | 5 |
| Esophagoscopy flex remove fb CPT 43215 | $3,379.77 | $6,627.00 | $2,238.00 – $4,737.00 | 5 |
| Esophagoscopy lesion ablate CPT 43229 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Esophagoscopy lesion removal CPT 43216 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Esophagoscopy retro balloon CPT 43213 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagoscopy rigid balloon CPT 43195 | not published | not published | $2,238.00 – $5,474.24 | 5 |
| Esophagoscopy/rigid/diagnostic 43191 CPT 43191 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagoscopy rigid trnso 43180 CPT 43180 | not published | not published | $2,238.00 – $8,405.34 | 5 |
| Esophagoscopy snare les remv CPT 43217 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagoscopy w/us needle bx CPT 43232 | not published | not published | $2,670.09 – $4,737.00 | 5 |
| Esophagoscp guide wire dilat 43196 CPT 43196 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagoscp rig trnso biopsy CPT 43193 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagoscp rig trnso inject CPT 43192 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagoscp rig trnso rem fb CPT 43194 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagotomy thrc rmvl fb CPT 43045 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Esophagus endoscopy/ligation CPT 43205 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esophagus motility study CPT 91010 | not published | not published | $257.68 – $1,716.00 | 4 |
| Esoph balloon distension tst CPT 91040 | not published | not published | $519.24 – $3,646.38 | 4 |
| Esoph egd dilation <30 mm CPT 43249 | $3,379.77 | $6,627.00 | $2,670.09 – $4,737.00 | 5 |
| Esoph endoscopy dilation CPT 43226 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esoph fundoplasty lap 43327 CPT 43327 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Esoph fundoplasty thor 43328 CPT 43328 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Esophgl motil w/stim/perfus CPT 91013 | not published | not published | $84.79 – $1,716.00 | 2 |
| Esoph imped function test CPT 91037 | not published | not published | $300.45 – $1,716.00 | 4 |
| Esoph imped funct test > 1hr CPT 91038 | not published | not published | $519.24 – $1,716.00 | 4 |
| Esoph optical endomicroscopy CPT 43206 | not published | not published | $2,670.09 – $4,737.00 | 5 |
| Esoph scope w/sclerosis inj CPT 43204 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esoph scope w/submucous inj CPT 43201 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Esphg dstl 2/3 w/laps moblj 43287 CPT 43287 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Esphg thrsc moblj CPT 43288 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Esphg tot w/laps moblj CPT 43286 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Esphg tot w/thrcm CPT 43112 | not published | not published | $4,233.00 – $12,568.00 | 3 |
| Essure 58565 CPT 58565 | not published | not published | $5,318.00 – $11,377.00 | 5 |
| Establish access to aorta CPT 36160 | $1,133.22 | $2,222.00 | $1,716.00 – $15,202.00 | 3 |
| Establish access to artery CPT 36100 | not published | not published | $1,141.57 – $4,042.00 | 3 |
| Establish brain cavity shunt CPT 62223 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Establish brain cavity shunt CPT 62180 | not published | not published | $2,995.00 – $9,773.00 | 3 |
| Establish brain cavity shunt CPT 62190 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Establish brain cavity shunt CPT 62192 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Establish brain cavity shunt CPT 62200 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Establish brain cavity shunt CPT 62220 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Estim aid bone healg invasiv CPT 20975 | not published | not published | $1,716.00 – $15,202.00 | 4 |
| Estradiol total CPT 82670 | $270.81 | $531.00 | $27.38 – $245.27 | 4 |
| Estradiol valerate 10 mg inj HCPCS J1380 | not published | not published | $13.63 – $15.70 | 3 |
| Estrogens total-sendout CPT 82672 | $73.90 | $144.90 | $21.27 – $190.38 | 4 |
| Etanercept injection HCPCS J1438 | not published | not published | $194.75 – $1,700.18 | 2 |
| Ethanolamine oleate 100 mg HCPCS J1430 | $1,514.53 | $2,969.66 | $80.49 – $1,070.06 | 4 |
| Eth estr and eton monthly HCPCS J7295 | not published | not published | $201.05 – $401.94 | 2 |
| Ethmoidectomy extranasal total 31205 CPT 31205 | not published | not published | $3,423.00 – $6,732.00 | 5 |
| Ethylene glycol -sendout CPT 82693 | $51.00 | $100.00 | $14.60 – $129.11 | 4 |
| Etonogestrel implant system HCPCS J7307 | $3,890.21 | $7,627.87 | $779.45 – $3,133.75 | 2 |
| Etoposide 20 mg/ml intravenous solution HCPCS J9181 | $226.39 | $443.90 | $2.13 – $18.83 | 3 |
| Etoposide 50 mg cap HCPCS J8560 | not published | not published | $52.77 – $164.39 | 4 |
| Euflexxa inj per dose HCPCS J7323 | not published | not published | $103.47 – $276.73 | 4 |
| Euglobulin lysis CPT 85360 | $46.03 | $90.25 | $8.24 – $71.32 | 4 |
| Evacuate mole of uterus CPT 59870 | not published | not published | $4,504.34 – $6,732.00 | 5 |
| Eval aud rehab status/first hr 92626 CPT 92626 | not published | not published | $179.04 – $182.70 | 2 |
| Eval/fit voice prosthesis iii, st CPT 92607 | $401.88 | $788.00 | $126.33 – $128.91 | 2 |
| Evaluation cervical mucus CPT 89330 | not published | not published | $10.17 – $86.86 | 4 |
| Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen CPT 84112 | $517.65 | $1,015.00 | $96.15 – $429.15 | 4 |
| Evaluation heart device CPT 93640 | not published | not published | $1,716.00 – $25,815.00 | 3 |
| Evaluation of speech fluency 92521 CPT 92521 | $348.33 | $683.00 | $145.64 – $148.61 | 2 |
| Evaluation psychiatric diagnostic CPT 90791 | $226.44 | $444.00 | $246.98 – $252.02 | 2 |
| Evasc prlng admn rx agnt 1st CPT 61650 | not published | not published | $691.00 – $6,732.00 | 3 |
| Evasc prlng admn rx agnt add CPT 61651 | not published | not published | $691.00 – $6,732.00 | 3 |
| Evasc repair of iliac artery; endograft 34718 CPT 34718 | not published | not published | $691.00 – $9,773.00 | 3 |
| Evasc rpr a-ao ndgft 34701 CPT 34701 | $10,179.09 | $19,959.00 | $2,238.00 – $20,652.00 | 4 |
| Evasc rpr a-ao ndgft rpt 34702 CPT 34702 | not published | not published | $2,238.00 – $20,652.00 | 4 |
| Evasc rpr a-biiliac ndgft rptr CPT 34706 | not published | not published | $2,238.00 – $20,652.00 | 4 |
| Evasc rpr a-iliac ndgft 34717 CPT 34717 | not published | not published | $691.00 – $9,773.00 | 3 |
| Evasc rpr a-unilac ndgft 34703 CPT 34703 | $5,689.05 | $11,155.00 | $2,238.00 – $20,652.00 | 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.