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 reticulocyte count CPT 85044 | not published | not published | $4.22 – $37.76 | 4 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $123.93 | $243.00 | $13.63 – $78.88 | 4 |
| Ghs sedimentation rate CPT 85651 | $140.25 | $275.00 | $4.18 – $31.14 | 4 |
| Ghs semen analysis fert CPT 89320 | not published | not published | $12.06 – $131.47 | 4 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $9.64 – $75.51 | 4 |
| Ghs sensitivity (per antimicro) CPT 87184 | not published | not published | $7.33 – $60.45 | 4 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $1,358.64 | $2,664.00 | $565.65 – $4,042.00 | 5 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $1,358.64 | $2,664.00 | $565.65 – $4,042.00 | 5 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $1,358.64 | $2,664.00 | $565.65 – $4,042.00 | 5 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $1,358.64 | $2,664.00 | $565.65 – $4,042.00 | 5 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $1,358.64 | $2,664.00 | $279.18 – $4,042.00 | 5 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $1,358.64 | $2,664.00 | $279.18 – $4,042.00 | 5 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $1,358.64 | $2,664.00 | $279.18 – $4,042.00 | 5 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $1,358.64 | $2,664.00 | $279.18 – $4,042.00 | 5 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $1,358.64 | $2,664.00 | $279.18 – $4,042.00 | 5 |
| Ghs sleep study unattended CPT 95800 | $1,197.48 | $2,348.00 | $300.45 – $1,103.10 | 3 |
| Ghs somatosensory testing lower extremit CPT 95926 | not published | not published | $298.21 – $306.58 | 3 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | not published | not published | $1,194.91 – $1,563.86 | 3 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | not published | not published | $49.49 – $50.50 | 2 |
| Ghs sphenopalatine ganglion block CPT 64505 | $589.05 | $1,155.00 | $427.11 – $4,042.00 | 5 |
| Ghs spont nystagmus CPT 92541 | not published | not published | $185.13 – $188.91 | 2 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $289.17 | $567.00 | $106.08 – $108.24 | 2 |
| Ghs strapping shoulder - 29240 CPT 29240 | $288.15 | $565.00 | $185.13 – $4,042.00 | 5 |
| Ghs st - re-eval for alt comm CPT 92597 | $294.27 | $577.00 | $72.86 – $74.35 | 2 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | $113.22 | $222.00 | $65.16 – $66.49 | 2 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | $551.31 | $1,081.00 | $295.97 – $302.01 | 2 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $1,714.11 | $3,361.00 | $1,028.39 – $4,042.00 | 5 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $808.35 | $1,585.00 | $565.65 – $4,042.00 | 5 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $3,024.81 | $5,931.00 | $2,158.97 – $5,318.00 | 5 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $7.15 – $64.05 | 4 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $951.66 | $1,866.00 | $343.23 – $4,042.00 | 5 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | $448.80 | $880.00 | $343.23 – $4,042.00 | 5 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $23.81 – $213.36 | 4 |
| Ghs urine, porphyrins quant CPT 84120 | $66.94 | $131.25 | $14.42 – $129.11 | 4 |
| Ghs vaginal delivery only CPT 59409 | $14,960.34 | $29,334.00 | $2,995.00 – $9,773.00 | 5 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $2,564.28 | $5,028.00 | $519.24 – $8,719.29 | 3 |
| Ghs windowing of cast CPT 29730 | $315.69 | $619.00 | $226.11 – $4,042.00 | 5 |
| Giardia ag if CPT 87269 | not published | not published | $13.34 – $81.84 | 4 |
| Giardia lamblia antibody CPT 86674 | not published | not published | $14.43 – $127.63 | 4 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $332.01 – $381.94 | 4 |
| Gi inhouse confirmation CPT 87045 | $104.55 | $205.00 | $9.25 – $82.78 | 4 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $2,995.00 – $11,377.00 | 5 |
| Gi protein loss CPT 78282 | not published | not published | $556.27 – $701.72 | 4 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | not published | not published | $1,262.04 – $6,306.71 | 4 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $1,294.00 – $4,371.02 | 3 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $1,262.04 – $5,091.94 | 4 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $1,262.04 – $7,677.00 | 5 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $99.10 – $202.24 | 4 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $60.29 – $123.04 | 4 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $34.30 – $70.00 | 4 |
| Glassia injection HCPCS J0257 | not published | not published | $5.55 – $11.72 | 4 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | not published | not published | $40.25 – $41.07 | 2 |
| Glaucoma surgery CPT 66150 | not published | not published | $4,233.00 – $9,773.00 | 5 |
| Glaucoma surgery CPT 66155 | not published | not published | $4,233.00 – $9,773.00 | 5 |
| Glaucoma surgery CPT 66160 | not published | not published | $2,995.00 – $9,773.00 | 5 |
| Glaucoma surgery CPT 66170 | not published | not published | $3,211.25 – $9,773.00 | 5 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $871.85 | $1,709.50 | $57.50 – $410.13 | 4 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $669.95 | $1,313.62 | $132.30 – $323.45 | 4 |
| Glucagon plasma - sendout CPT 82943 | $69.32 | $135.92 | $14.00 – $106.47 | 4 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $45.15 – $343.41 | 4 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $49.49 – $376.33 | 4 |
| Glucagon tolerance test CPT 82946 | not published | not published | $17.41 – $112.32 | 4 |
| Glucose 1 hr post dose CPT 82950 | $295.29 | $579.00 | $4.66 – $41.66 | 4 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $5.93 – $53.24 | 4 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $92.31 | $181.00 | $3.21 – $6.56 | 3 |
| Glucose blood quantitative CPT 82947 | $156.06 | $306.00 | $3.85 – $34.51 | 4 |
| Glucose body fluid CPT 82945 | $175.44 | $344.00 | $3.85 – $34.39 | 4 |
| Glucose monitoring continual min 72hr pt CPT 95249 | not published | not published | $82.09 – $389.21 | 3 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $436.05 | $855.00 | $12.61 – $112.97 | 4 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $56.61 | $111.00 | $3.84 – $34.45 | 4 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $84.15 | $165.00 | $1.02 – $1.95 | 3 |
| Gold sodium thiomaleate inj HCPCS J1600 | not published | not published | $14.10 – $28.51 | 2 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | not published | not published | $11.06 – $32.92 | 4 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $194.31 | $381.00 | $18.21 – $163.08 | 4 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $145.44 – $296.82 | 4 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $184.11 | $361.00 | $18.15 – $162.55 | 4 |
| Gonioscopy CPT 92020 | not published | not published | $185.13 – $188.91 | 2 |
| Goniotomy CPT 65820 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | not published | not published | $622.72 – $1,516.05 | 3 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $4,070.57 | $7,981.50 | $49.15 – $176.69 | 4 |
| Graft axiofill 1000mg HCPCS J3590 | $18,618.01 | $36,505.90 | not published | 0 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $173.16 – $2,270.34 | 4 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $33,868.77 | $66,409.35 | $136.78 – $219.73 | 4 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $57,852.99 | $113,437.24 | not published | 0 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | not published | not published | $1,070.17 – $4,294.63 | 2 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $76,755.00 | $150,500.00 | not published | 0 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $67,861.21 | $133,061.20 | not published | 0 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $58,721.35 | $115,139.91 | $50.08 – $176.69 | 4 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $39,559.68 | $77,568.00 | $173.16 – $691.00 | 4 |
| Graft repair of spine defect 63710 CPT 63710 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $27,815.40 | $54,540.00 | $173.16 – $293.20 | 4 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | not published | not published | $111.35 – $176.69 | 3 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $72,183.01 | $141,535.32 | not published | 0 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $8,482.32 | $16,632.00 | $80.63 – $210.42 | 4 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $100,184.40 | $196,440.00 | not published | 0 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $5,410.08 | $10,608.00 | not published | 0 |
| Granisetron 1 mg tab HCPCS Q0166 | not published | not published | $65.38 – $110.94 | 2 |
| Granisetron hcl injection HCPCS J1626 | not published | not published | $0.52 – $24.67 | 3 |
| Great toe-hand transfer CPT 26551 | not published | not published | $6,682.00 – $11,377.00 | 5 |
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.