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 |
|---|---|---|---|---|
| Ghs histoplasma antigen CPT 87385 | $58.97 | $115.63 | $12.98 – $78.88 | 4 |
| Ghs HIV antibody CPT 86703 | $41.64 | $81.65 | $13.44 – $124.02 | 4 |
| Ghs hla-dr/dq, multiple antigens CPT 86817 | not published | not published | $104.02 – $479.73 | 4 |
| Ghs i and d abscess/hematoma scrotum CPT 54700 | $3,608.25 | $7,075.00 | $2,908.69 – $6,732.00 | 5 |
| Ghs i and d perirectal abscess 46040 CPT 46040 | $4,938.33 | $9,683.00 | $1,665.08 – $4,737.00 | 5 |
| Ghs i and d pilonidal cyst complex CPT 10081 | $3,021.24 | $5,924.00 | $985.34 – $4,042.00 | 5 |
| Ghs i and d pilonidal cyst simple CPT 10080 | $2,244.00 | $4,400.00 | $691.00 – $4,042.00 | 5 |
| Ghs immun0electrophoresis CPT 86320 | not published | not published | $29.32 – $196.70 | 4 |
| Ghs incision thrombosed ext hemorrhoid CPT 46083 | $374.34 | $734.00 | $347.66 – $4,042.00 | 5 |
| Ghs indirect laryngoscopy/w fb removal CPT 31511 | $535.50 | $1,050.00 | $277.75 – $4,042.00 | 5 |
| Ghs inf midline insertion CPT 36140 | $2,355.69 | $4,619.00 | $740.18 – $4,042.00 | 3 |
| Ghs inhibitor screen CPT 85335 | $103.04 | $202.03 | $12.61 – $112.97 | 4 |
| Ghs init tx 1st degree burn CPT 16000 | $408.51 | $801.00 | $279.18 – $4,042.00 | 5 |
| Ghs inj neurolytic intercostal nerve CPT 64620 | $2,996.25 | $5,875.00 | $1,230.71 – $4,042.00 | 5 |
| Ghs inj neurolytic other perph nerve CPT 64640 | $3,037.05 | $5,955.00 | $1,230.71 – $4,042.00 | 5 |
| Ghs inj tendon origin/insertion CPT 20551 | $589.05 | $1,155.00 | $427.11 – $4,042.00 | 5 |
| Ghs inj transforaminal cerv ea add bil CPT 64480 | not published | not published | $1,716.00 – $12,908.00 | 4 |
| Ghs inj transforaminal cerv single bil CPT 64479 | $2,984.52 | $5,852.00 | $1,230.71 – $4,042.00 | 5 |
| Ghs insertion of needle - bone CPT 36680 | $669.63 | $1,313.00 | $621.60 – $4,042.00 | 5 |
| Ghs intermed repair 12.6 - 20.0 cm-12035 CPT 12035 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs intermed repair 20.1 - 30.0 cm-12036 CPT 12036 | $2,147.10 | $4,210.00 | $1,028.39 – $4,042.00 | 5 |
| Ghs intermed repair over 30 cm - 12037 CPT 12037 | $3,693.93 | $7,243.00 | $2,870.98 – $4,737.00 | 5 |
| Ghs intro needle/intracath vein - 36000 CPT 36000 | $412.08 | $808.00 | $1,716.00 – $4,042.00 | 2 |
| Ghs irrigate corpora cavernosa for priapism CPT 54220 | $661.47 | $1,297.00 | $347.66 – $4,042.00 | 5 |
| Ghs IV inf sq injection, on-body injector CPT 96377 | not published | not published | $65.16 – $66.49 | 2 |
| Ghs IV thrombolytics - cerebral CPT 37195 | $355.47 | $697.00 | $459.61 – $4,042.00 | 5 |
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $498.27 | $977.00 | $621.60 – $4,042.00 | 5 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $2,147.10 | $4,210.00 | $1,028.39 – $4,042.00 | 5 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | $2,223.60 | $4,360.00 | $1,028.39 – $4,042.00 | 5 |
| Ghs layered repair 12.6 - 20.0 cm -12055 CPT 12055 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs layered repair 20.1 - 30.0 cm -12046 CPT 12046 | $2,223.60 | $4,360.00 | $1,028.39 – $4,042.00 | 5 |
| Ghs layered repair 20.1 - 30.0 cm -12056 CPT 12056 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs layered repair over 30.0 cm -12047 CPT 12047 | $3,738.30 | $7,330.00 | $2,870.98 – $4,737.00 | 5 |
| Ghs layered repair over 3.0 cm -12057 CPT 12057 | $2,147.10 | $4,210.00 | $565.65 – $4,042.00 | 5 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | not published | not published | $8.43 – $75.45 | 4 |
| Ghs mbp CPT 83873 | $60.51 | $118.65 | $16.86 – $146.12 | 4 |
| Ghs moderate sedation < 5 yr, 30 min CPT 99151 | $403.41 | $791.00 | not published | 0 |
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $604.35 | $1,185.00 | not published | 0 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $403.41 | $791.00 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $68.85 | $135.00 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $136.68 | $268.00 | not published | 0 |
| Ghs musc test done w/n test comp CPT 95886 | not published | not published | $248.58 – $248.58 | 1 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | not published | not published | $235.76 – $235.76 | 1 |
| Ghs musc tst done w/n tst non ext CPT 95887 | not published | not published | $252.72 – $252.72 | 1 |
| Ghs myocardial strain img spckl track CPT 93356 | not published | not published | $108.52 – $334.20 | 2 |
| Ghs nailbed repair/nail removal CPT 11760 | $1,531.53 | $3,003.00 | $1,028.39 – $4,042.00 | 5 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | $1,916.07 | $3,757.00 | $1,230.71 – $4,042.00 | 5 |
| Ghs nerve blk intercostal, single level CPT 64420 | $1,916.07 | $3,757.00 | $982.21 – $4,042.00 | 5 |
| Ghs nerve block axillary nerve CPT 64417 | $1,845.69 | $3,619.00 | $1,230.71 – $4,042.00 | 5 |
| Ghs nerve block brachial plexus CPT 64415 | $1,809.48 | $3,548.00 | $1,230.71 – $4,042.00 | 5 |
| Ghs nerve block celiac plexus CPT 64530 | $3,313.98 | $6,498.00 | $1,230.71 – $4,042.00 | 5 |
| Ghs nerve block interscaline CPT 64510 | $3,313.98 | $6,498.00 | $1,230.71 – $4,042.00 | 5 |
| Ghs nerve block lumbar or thoracic symp CPT 64520 | $2,107.32 | $4,132.00 | $1,230.71 – $4,042.00 | 5 |
| Ghs nerve block sciatic nerve CPT 64445 | $2,107.32 | $4,132.00 | $691.00 – $4,042.00 | 5 |
| Ghs nerve block suprascapular CPT 64418 | not published | not published | $982.21 – $4,042.00 | 5 |
| Ghs ng placement w fluoro guidance CPT 43752 | $863.43 | $1,693.00 | $621.60 – $4,042.00 | 5 |
| Ghs o2 saturation CPT 82810 | not published | not published | $9.57 – $76.58 | 4 |
| Ghs o2 uptake rest & exercise CPT 94680 | not published | not published | $167.93 – $182.70 | 3 |
| Ghs o2 uptake rest & indirect CPT 94690 | $111.18 | $218.00 | $82.09 – $274.22 | 3 |
| Ghs ob unlisted IV or art inj or infusion CPT 96379 | $113.22 | $222.00 | $65.16 – $66.49 | 2 |
| Ghs opcc repair cvp without subq port CPT 36575 | $1,253.58 | $2,458.00 | $872.87 – $4,042.00 | 5 |
| Ghs opcc repair cvp w subq port CPT 36576 | $3,471.57 | $6,807.00 | $2,190.38 – $4,042.00 | 5 |
| Ghs optokenetic CPT 92544 | not published | not published | $179.04 – $182.70 | 2 |
| Ghs oscillating trac CPT 92545 | not published | not published | $300.45 – $306.58 | 2 |
| Ghs ot dds rom CPT 95851 | not published | not published | $6.58 – $157.59 | 3 |
| Ghs ot group caregiver training CPT 97552 | not published | not published | $9.90 – $691.00 | 3 |
| Ghs ot prosthetic training/15 min CPT 97761 | $103.53 | $203.00 | $45.17 – $46.09 | 2 |
| Ghs ot sensory integrative tech/15min CPT 97533 | not published | not published | $63.87 – $65.17 | 2 |
| Ghs pacing - transcutaneous CPT 92953 | $1,724.31 | $3,381.00 | $919.68 – $4,042.00 | 4 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $2,079.78 | $4,078.00 | $1,716.00 – $12,908.00 | 4 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $2,317.95 | $4,545.00 | $1,716.00 – $12,908.00 | 4 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | not published | not published | $52.70 – $165.52 | 3 |
| Ghs peritonsillar abscess i andd CPT 42700 | $652.29 | $1,279.00 | $329.57 – $4,042.00 | 5 |
| Ghs phenylketonurid CPT 84030 | not published | not published | $5.39 – $48.33 | 4 |
| Ghs picc line insert < 5 CPT 36568 | $3,222.69 | $6,319.00 | $2,190.38 – $4,042.00 | 5 |
| Ghs plngl fx pm cl CPT 26725 | $847.62 | $1,662.00 | $343.23 – $4,042.00 | 5 |
| Ghs plt ct-manual CPT 85032 | not published | not published | $4.22 – $37.82 | 4 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | $8,542.50 | $16,750.00 | $1,194.91 – $6,816.69 | 3 |
| Ghs pos nystagmus CPT 92542 | not published | not published | $185.13 – $188.91 | 2 |
| Ghs ppd (tb intradermal) CPT 86580 | not published | not published | $40.25 – $62.45 | 4 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | not published | not published | $9.47 – $84.91 | 4 |
| Ghs protein, misc fluid CPT 84160 | not published | not published | $5.50 – $45.38 | 4 |
| Ghs protoporphyrins fract CPT 84202 | not published | not published | $14.06 – $125.97 | 4 |
| Ghs pr without cont pulse ox CPT 94625 | $907.80 | $1,780.00 | $82.09 – $83.76 | 2 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | not published | not published | $12.00 – $107.48 | 4 |
| Ghs quinidine CPT 80194 | not published | not published | $14.31 – $128.10 | 4 |
| Ghs refill of implantable pump CPT 95990 | $555.90 | $1,090.00 | $459.61 – $4,042.00 | 4 |
| Ghs removal intranasal foreign body CPT 30300 | $443.19 | $869.00 | $185.13 – $4,042.00 | 5 |
| Ghs removal pharyngeal foreign body CPT 42809 | $599.76 | $1,176.00 | $621.60 – $4,042.00 | 5 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $4,299.81 | $8,431.00 | $2,237.46 – $5,318.00 | 5 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $6,447.42 | $12,642.00 | $4,233.00 – $11,377.00 | 5 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | not published | not published | $15.57 – $112.97 | 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.