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 |
|---|---|---|---|---|
| Hzv zoster vacc recombinant adjuvanted im inj CPT 90750 | not published | not published | $200.31 – $200.31 | 1 |
| I-123 iobenguane diag HCPCS A9582 | not published | not published | $2,271.15 – $4,842.66 | 4 |
| I-123 ioflupane diag HCPCS A9584 | not published | not published | $1,359.99 – $3,229.28 | 4 |
| I-123 sod iodide diag per 100 uci HCPCS A9516 | not published | not published | $81.62 – $239.94 | 2 |
| I125 iothalamate, dx HCPCS A9554 | not published | not published | $50.08 – $649.64 | 4 |
| I125 serum albumin, dx HCPCS A9532 | not published | not published | $22.42 – $469.06 | 4 |
| I-131 iobenguane sulf diag mibg HCPCS A9508 | not published | not published | $622.07 – $2,215.70 | 4 |
| I131 iodide cap, rx HCPCS A9517 | not published | not published | $23.59 – $206.85 | 4 |
| I131 iodide sol, rx HCPCS A9530 | not published | not published | $20.35 – $44.89 | 3 |
| I131 max 100uci HCPCS A9531 | not published | not published | $9.05 – $9.05 | 1 |
| I131 serum albumin, dx HCPCS A9524 | not published | not published | $64.86 – $774.73 | 2 |
| Iaadi respiratory synctial virus CPT 87280 | $24.54 | $48.11 | $13.15 – $78.88 | 4 |
| Iadna legionella pneumophila amplified probe tq CPT 87541 | not published | not published | $34.39 – $298.03 | 4 |
| Ia infect ag ab qual/semiquant sgl step CPT 86318 | not published | not published | $17.73 – $113.62 | 4 |
| Ia nfct ab sarscov2 covid19 CPT 86328 | not published | not published | $44.37 – $267.25 | 4 |
| Ibandronate 3 mg/3 ml intravenous syringe HCPCS J1740 | not published | not published | $44.44 – $200.59 | 3 |
| Ibmfs seq alys pnl 30 genes CPT 81441 | not published | not published | $2,399.59 – $12,992.11 | 4 |
| Ibuprofen injection HCPCS J1741 | not published | not published | $5.95 – $19.20 | 3 |
| Ibutilide fumarate 0.1 mg/ml intravenous solution HCPCS J1742 | $299.18 | $586.62 | $214.83 – $401.56 | 4 |
| Icatibant injection HCPCS J1744 | not published | not published | $250.63 – $324.30 | 3 |
| Icd cobalt xt dr MRI is1 df1 HCPCS C1721 | $78,290.10 | $153,510.00 | not published | 0 |
| Icd crtd cobalt hf MRI is1 df1 HCPCS C1882 | $81,667.32 | $160,132.00 | not published | 0 |
| Icd crtp serena MRI HCPCS C2621 | $22,325.76 | $43,776.00 | not published | 0 |
| Icd reliance df4 ib 64cm HCPCS C1895 | $17,271.46 | $33,865.60 | not published | 0 |
| Icg angiography i&r uni/bi CPT 92240 | not published | not published | $300.45 – $4,042.00 | 3 |
| Icut allergy test-delayed CPT 95028 | not published | not published | $51.97 – $59.97 | 3 |
| Icut allergy test drug/bug CPT 95024 | not published | not published | $38.88 – $83.76 | 3 |
| Icut allergy titrate-airborn CPT 95027 | not published | not published | $38.88 – $41.07 | 3 |
| I&d abscess posterior spine l/s/ls-22015 CPT 22015 | not published | not published | $4,042.00 – $15,575.00 | 4 |
| I&d abscss rtrphryngl/paraphryngl intraorl apprch CPT 42720 | $6,161.82 | $12,082.00 | $2,238.00 – $4,737.00 | 5 |
| Idarubicin hcl injection HCPCS J9211 | $530.27 | $1,039.75 | $87.01 – $585.63 | 3 |
| I&d/bursa/foot 28001 CPT 28001 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Idecabtagene vicleucel car HCPCS Q2055 | not published | not published | $548,585.46 – $1,134,388.29 | 3 |
| Identify sperm tissue CPT 89264 | not published | not published | $72.51 – $508.15 | 4 |
| Idet 1 or more levels CPT 22527 | not published | not published | $4,042.00 – $19,505.00 | 3 |
| Idet single level CPT 22526 | not published | not published | $4,042.00 – $19,505.00 | 3 |
| I&d frarm&/wrst deep absc/hematoma CPT 25028 | $6,447.42 | $12,642.00 | $2,238.00 – $6,732.00 | 5 |
| Idh1 common variants CPT 81120 | $135.47 | $265.62 | $189.38 – $1,318.82 | 4 |
| Idh2 common variants CPT 81121 | $135.47 | $265.63 | $289.87 – $2,018.65 | 4 |
| I&d intramural/intramuscular/submuc abscess transanal anes CPT 46045 | $5,420.79 | $10,629.00 | $2,995.00 – $6,732.00 | 5 |
| I&d lacrimal gland CPT 68400 | $2,646.39 | $5,189.00 | $691.00 – $4,737.00 | 5 |
| I&d lacrimal sac CPT 68420 | not published | not published | $2,741.00 – $4,042.00 | 5 |
| I&d upper arm/elbow deep abscess/hematoma CPT 23930 | $5,595.21 | $10,971.00 | $2,238.00 – $6,732.00 | 5 |
| Idursulfase injection HCPCS J1743 | not published | not published | $547.06 – $1,166.53 | 4 |
| I & d vag hematoma non-ob 57023 CPT 57023 | $5,595.21 | $10,971.00 | $2,238.00 – $6,732.00 | 5 |
| I&d vag hemtma obst/postpart CPT 57022 | $5,595.21 | $10,971.00 | $2,238.00 – $4,737.00 | 5 |
| Ifnl3 gene CPT 81283 | not published | not published | $71.90 – $473.82 | 4 |
| Ifosfamide 1 gram intravenous solution HCPCS J9208 | $575.40 | $1,128.24 | $49.24 – $188.81 | 3 |
| Igh@/bcl2 translocation alys CPT 81278 | not published | not published | $203.16 – $617.34 | 4 |
| Igh gene rearrang dir probe CPT 81262 | not published | not published | $67.18 – $352.87 | 4 |
| Igh gene rearrange amp meth CPT 81261 | not published | not published | $194.03 – $707.68 | 4 |
| Igh@ var region somatic mutation analy CPT 81263 | not published | not published | $288.63 – $1,006.61 | 4 |
| Igk rearrangeabn clonal pop CPT 81264 | not published | not published | $169.28 – $2,129.97 | 4 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $282.54 | $554.00 | $129.20 – $374.85 | 3 |
| Ihc/icc per specimen each multiplex antibody stain CPT 88344 | $474.30 | $930.00 | $462.93 – $630.64 | 4 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $276.42 | $542.00 | $83.67 – $287.00 | 4 |
| Iiv3 vacc no prsv 0.25 ml im CPT 90655 | not published | not published | $19.85 – $27.69 | 2 |
| Ikbkap gene CPT 81260 | not published | not published | $38.52 – $503.42 | 4 |
| Ileostomy/jejunostomy non-tube 44310 CPT 44310 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Iliac bone graft microvasc CPT 20956 | not published | not published | $5,530.00 – $15,575.00 | 5 |
| Iliac/fem angio cath insert HCPCS G0278 | $2,443.41 | $4,791.00 | $82.54 – $93.52 | 2 |
| Iliac revasc add-on 37222 CPT 37222 | $5,049.51 | $9,901.00 | $4,042.00 – $15,575.00 | 4 |
| Iloprost non-comp unit dose HCPCS Q4074 | not published | not published | $88.75 – $319.83 | 2 |
| Imatinib 100 mg tab HCPCS S0088 | not published | not published | $89.83 – $89.83 | 1 |
| Imbrication/diaphragm/transthor/transabd 39545 CPT 39545 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Imetelstat 188 mg intravenous solution HCPCS J0870 | not published | not published | $57.01 – $119.35 | 4 |
| Img rta detcj/mntr ds staff CPT 92227 | not published | not published | $62.87 – $83.76 | 3 |
| Img rta detc/mntr ds phy/qhp CPT 92228 | not published | not published | $51.97 – $68.66 | 3 |
| Img rta detc/mntr ds poc aly CPT 92229 | not published | not published | $82.09 – $83.76 | 2 |
| Immobilizer lwr extrem nylon 20in reinforc 21-35in HCPCS L2999 | $418.76 | $821.10 | not published | 0 |
| Immobilizer shldr cntor adlt HCPCS L3670 | $247.86 | $486.00 | not published | 0 |
| Immobilizer shldr dlx str 24-36in med HCPCS L1830 | $196.15 | $384.60 | not published | 0 |
| Immt breast prosthesis 19340 CPT 19340 | not published | not published | $2,995.00 – $11,605.08 | 5 |
| Immune complex assay CPT 86332 | not published | not published | $23.88 – $213.89 | 4 |
| Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution HCPCS J1569 | $5,252.62 | $10,299.25 | $48.10 – $97.03 | 4 |
| Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution HCPCS J1566 | $2,046.57 | $4,012.88 | $53.04 – $174.17 | 4 |
| Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution HCPCS J1568 | not published | not published | $46.09 – $103.33 | 4 |
| Immune globulin ig human im use 90281 CPT 90281 | not published | not published | $24.58 – $128.44 | 2 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $168.30 | $330.00 | $20.39 – $182.52 | 4 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $244.29 | $479.00 | $20.39 – $182.52 | 4 |
| Immunoassay tumor qual CPT 86294 | not published | not published | $25.06 – $145.35 | 4 |
| Immunodiff gel qual ea antigen/ab CPT 86331 | $14.36 | $28.15 | $11.74 – $105.17 | 4 |
| Immunodiffusion nes CPT 86329 | $8.67 | $17.00 | $13.77 – $112.56 | 4 |
| Immunoelectrophoresis assay CPT 86327 | not published | not published | $192.62 – $192.62 | 1 |
| Immunofixation electrophoresis serum CPT 86334 | $79.05 | $155.00 | $21.89 – $196.05 | 4 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | $86.19 | $169.00 | $127.76 – $468.32 | 3 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | $582.42 | $1,142.00 | $66.24 – $566.82 | 4 |
| Immunoglobulin assay CPT 86023 | $94.35 | $185.00 | $12.21 – $94.24 | 4 |
| Impedence cardiogram CPT 93701 | not published | not published | $174.13 – $188.91 | 3 |
| Imp extar knee shck absrb HCPCS C8003 | not published | not published | $2,995.00 – $24,895.59 | 4 |
| Impl absrb msh/prsth dly cls CPT 15778 | not published | not published | $691.00 – $19,505.00 | 4 |
| Impl ahmed 6x25x9.6mm glaucoma vlv w/sil ped ster HCPCS L8612 | $8,017.36 | $15,720.32 | not published | 0 |
| Implant 11 volt lithium-ion backup battery for controller pocket HCPCS Q0506 | $2,175.66 | $4,266.00 | not published | 0 |
| Implantation iris prosthesis CPT 66683 | not published | not published | $2,238.00 – $23,372.09 | 5 |
| Implant biventricular device 33976 CPT 33976 | not published | not published | $6,732.00 – $12,568.00 | 2 |
| Implant brain electrodes CPT 61531 | not published | not published | $2,238.00 – $5,318.00 | 3 |
| Implant brain electrodes CPT 61533 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Implant brain electrodes CPT 61760 | not published | not published | $2,995.00 – $9,773.00 | 3 |
| Implant cartilage 10mm synthetic HCPCS L8699 | $10,924.20 | $21,420.00 | not published | 0 |
| Implant cochlear device CPT 69930 | not published | not published | $6,682.00 – $45,879.53 | 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.