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 |
|---|---|---|---|---|
| Fth/gft fr n/e/e/l each addl CPT 15261 | not published | not published | $1,716.00 – $15,202.00 | 4 |
| Fth/gft fr trnk each addl CPT 15201 | not published | not published | $1,716.00 – $15,202.00 | 4 |
| Ftl cgen abnor 3 proteins CPT 81509 | not published | not published | $389.30 – $7,891.96 | 4 |
| Ftl cgen abnor five anal CPT 81512 | not published | not published | $68.13 – $368.88 | 4 |
| Ftl cgen abnor four anal CPT 81511 | $247.35 | $485.00 | $150.43 – $814.46 | 4 |
| Ftl cgen abnor three anal CPT 81510 | not published | not published | $54.43 – $294.73 | 4 |
| Ftl cgen abnor two proteins CPT 81508 | not published | not published | $53.21 – $288.11 | 4 |
| Full field erg w/i&r CPT 92273 | not published | not published | $300.45 – $601.80 | 3 |
| Full mouth x-ray of teeth CPT 70320 | not published | not published | $197.59 – $372.86 | 4 |
| Full thick gft/nose/ear/lid/lip/20sqcm or< 15260 CPT 15260 | $3,760.74 | $7,374.00 | $2,870.98 – $4,737.00 | 5 |
| Full thick gft/scalp/arm/leg/20sqcm or< 15220 CPT 15220 | not published | not published | $2,870.98 – $4,737.00 | 5 |
| Full thick gft/scalp/arm/leg/add 20sqcm 15221 CPT 15221 | not published | not published | $1,716.00 – $15,202.00 | 4 |
| Full thick gft w/close donor fccmnaghf <=20sqcm 15240 CPT 15240 | $3,760.74 | $7,374.00 | $2,870.98 – $5,318.00 | 5 |
| Fundus photography with i&r 92250 CPT 92250 | not published | not published | $185.13 – $4,042.00 | 3 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | $84.15 | $165.00 | $0.04 – $0.04 | 2 |
| Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr HCPCS J1940 | not published | not published | $1.48 – $1.48 | 1 |
| Fuse bile ducts and bowel 47785 CPT 47785 | not published | not published | $2,995.00 – $9,773.00 | 3 |
| Fuse esophagus & intestine CPT 43340 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Fuse esophagus & intestine CPT 43341 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Fuse esophagus & stomach CPT 43320 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Fuse gallbladder & bowel CPT 47740 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Fuse gallbladder & bowel CPT 47741 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Fuse/graft added joint CPT 26863 | not published | not published | $1,716.00 – $19,505.00 | 4 |
| Fuse liver duct & intestine CPT 47802 | not published | not published | $9,773.00 – $9,773.00 | 1 |
| Fuse liver ducts & bowel CPT 47765 | not published | not published | $2,995.00 – $9,773.00 | 3 |
| Fuse pancreas and bowel CPT 48548 | not published | not published | $6,732.00 – $9,773.00 | 2 |
| Fuse pancreas cyst and bowel CPT 48540 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Fuse pancreas cyst and bowel 48520 CPT 48520 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Fuse upper gi structures CPT 47721 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Fusion/graft of finger joint CPT 26862 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Fusion/graft of hand joint CPT 26844 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Fusion of ankle joint open CPT 27870 | not published | not published | $4,233.00 – $18,229.15 | 5 |
| Fusion of big toe joint CPT 28750 | not published | not published | $4,233.00 – $15,575.00 | 5 |
| Fusion of big toe joint CPT 28755 | not published | not published | $4,233.00 – $10,302.82 | 5 |
| Fusion of facial/other nerve CPT 64866 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Fusion of finger jnt add-on CPT 26861 | not published | not published | $1,716.00 – $15,202.00 | 4 |
| Fusion of finger joint CPT 26860 | $6,447.42 | $12,642.00 | $3,423.00 – $11,377.00 | 5 |
| Fusion of finger tendons CPT 26471 | not published | not published | $2,995.00 – $4,737.00 | 5 |
| Fusion of finger tendons CPT 26474 | not published | not published | $2,237.46 – $4,737.00 | 5 |
| Fusion of foot bones CPT 28730 | not published | not published | $4,233.00 – $18,229.15 | 5 |
| Fusion of foot bones CPT 28735 | not published | not published | $4,233.00 – $18,229.15 | 5 |
| Fusion of foot bones CPT 28740 | not published | not published | $4,233.00 – $15,575.00 | 5 |
| Fusion of hand joint CPT 26843 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Fusion of knee CPT 27580 | not published | not published | $3,423.00 – $18,229.15 | 5 |
| Fusion of knuckle CPT 26850 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Fusion of knuckle joint CPT 26516 | not published | not published | $2,238.00 – $11,377.00 | 5 |
| Fusion of knuckle joints CPT 26517 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Fusion of knuckle joints CPT 26518 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Fusion of knuckle with graft CPT 26852 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Fusion of skull arteries CPT 61711 | not published | not published | $4,233.00 – $12,568.00 | 3 |
| Fusion of spermatic ducts CPT 54900 | not published | not published | $2,908.69 – $9,773.00 | 5 |
| Fusion of spermatic ducts CPT 54901 | not published | not published | $4,233.00 – $9,773.00 | 5 |
| Fusion of tendons at wrist CPT 25300 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Fusion of tendons at wrist CPT 25301 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Fusion of thumb CPT 26841 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Fusion of tibiofibular joint CPT 27871 | not published | not published | $4,233.00 – $18,229.15 | 5 |
| Fusion of toes CPT 28280 | not published | not published | $2,995.00 – $6,732.00 | 5 |
| Fusion of ureter & bowel CPT 50810 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Fusion of ureter & kidney CPT 50740 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Fusion of ureter & kidney CPT 50750 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Fxn gene charac alleles CPT 81285 | not published | not published | $269.33 – $1,435.52 | 4 |
| Fxn gene detc abnor alleles CPT 81284 | not published | not published | $134.26 – $715.60 | 4 |
| Fxn gene full gene sequence CPT 81286 | not published | not published | $269.33 – $1,435.52 | 4 |
| Fxn gene known famil variant CPT 81289 | not published | not published | $181.50 – $967.37 | 4 |
| G6pc gene CPT 81250 | not published | not published | $57.32 – $503.42 | 4 |
| G6pd full gene sequence CPT 81249 | not published | not published | $588.00 – $3,768.57 | 4 |
| G6pd gene alys cmn variant CPT 81247 | not published | not published | $171.31 – $1,097.95 | 4 |
| G6pd known familial variant CPT 81248 | not published | not published | $367.74 – $2,356.92 | 4 |
| Ga-67 gallium 0.1 mci HCPCS A9556 | not published | not published | $32.19 – $47.30 | 2 |
| Ga-68 gallium 68 dotatate HCPCS A9587 | not published | not published | $48.64 – $109.84 | 4 |
| Gabapentin non-blood CPT 80355 | $5.56 | $10.91 | $0.07 – $106.59 | 2 |
| Gadobutrol 1 mmol/ml intravenous solution (wrapper) HCPCS A9585 | not published | not published | $0.56 – $1.19 | 2 |
| Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper) HCPCS A9579 | not published | not published | $3.20 – $5.13 | 2 |
| Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution HCPCS A9575 | not published | not published | $0.26 – $0.68 | 2 |
| Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution HCPCS A9581 | not published | not published | $18.60 – $112.50 | 3 |
| Galac-1-phosphate uridyltran - sendout CPT 82775 | not published | not published | $20.65 – $184.94 | 4 |
| Galactokinase - sendout CPT 82759 | not published | not published | $21.05 – $189.20 | 4 |
| Galactose transferase test CPT 82776 | not published | not published | $11.51 – $73.56 | 4 |
| Galectin-3 CPT 82777 | not published | not published | $43.36 – $88.50 | 4 |
| Gallbladder Removal (Laparoscopic) CPT 47562 | not published | not published | $6,682.00 – $15,575.00 | 5 |
| Gallium ga-68 dotatoc HCPCS C9067 | not published | not published | $0.78 – $8.71 | 4 |
| Gallium ga-68 psma-11, ucla HCPCS A9594 | not published | not published | $356.23 – $990.63 | 4 |
| Gallium ga-68 psma-11 ucsf HCPCS A9593 | not published | not published | $539.13 – $1,150.06 | 4 |
| Gallium illuccix 1 millicure HCPCS A9596 | not published | not published | $468.95 – $2,216.65 | 4 |
| Gallium locametz 1 millicuri HCPCS A9800 | not published | not published | $355.25 – $1,873.21 | 4 |
| Gallium nitrate injection HCPCS J1457 | not published | not published | $1.85 – $2.77 | 2 |
| Galsulfase injection HCPCS J1458 | not published | not published | $432.15 – $1,042.49 | 4 |
| Gamma globulin > 10 cc inj HCPCS J1560 | not published | not published | $52.95 – $1,051.03 | 4 |
| Gamma globulin 1 cc inj HCPCS J1460 | $1,474.06 | $2,890.31 | $14.37 – $105.11 | 4 |
| Gammaglobulin iga CPT 82784 | $91.29 | $179.00 | $9.11 – $68.01 | 4 |
| Gammaglobulin ige CPT 82785 | $104.55 | $205.00 | $16.13 – $144.53 | 4 |
| Gamma glutamyltransferase CPT 82977 | $263.16 | $516.00 | $7.06 – $63.46 | 4 |
| Gammagraft HCPCS Q4111 | not published | not published | $16.34 – $176.69 | 3 |
| Gammaplex injection HCPCS J1557 | not published | not published | $63.36 – $123.58 | 4 |
| Gamunex-c/gammaked HCPCS J1561 | $6,349.04 | $12,449.10 | $48.73 – $103.95 | 4 |
| Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr HCPCS J1570 | $173.00 | $339.22 | $46.18 – $68.99 | 3 |
| Ganciclovir long act implant HCPCS J7310 | not published | not published | $6,624.13 – $8,825.26 | 2 |
| Gardner vag dna amp probe CPT 87511 | not published | not published | $34.39 – $298.03 | 4 |
| Gardner vag dna quant CPT 87512 | $83.13 | $163.00 | $40.92 – $227.07 | 4 |
| Gastric analy w/ph ea spec CPT 82930 | not published | not published | $6.58 – $34.80 | 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.