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 |
|---|---|---|---|---|
| Infect ag eia influenza a or b ea CPT 87400 | not published | not published | $13.85 – $40.77 | 4 |
| Infect ag genotype na cytomegalovirus CPT 87910 | not published | not published | $252.30 – $1,712.52 | 4 |
| Infect ag genotype na dna hepatitis b CPT 87912 | $212.06 | $415.80 | $252.30 – $1,712.52 | 4 |
| Infect ag genotype na hiv-1 other region CPT 87906 | $235.62 | $462.00 | $126.16 – $857.65 | 4 |
| Infect ag genotype na hiv-1 revr trn/prt CPT 87901 | $117.81 | $231.00 | $252.30 – $2,258.01 | 4 |
| Infect ag ia direct hiv-1 antgn CPT 87806 | $55.59 | $109.00 | $32.11 – $151.79 | 4 |
| Infect ag ia optc obs chlamydia trach CPT 87810 | not published | not published | $34.58 – $78.88 | 4 |
| Infect ag ia optc obs influenza CPT 87804 | $28.05 | $55.00 | $16.22 – $78.88 | 4 |
| Infect ag if ea plyvlnt antsrm CPT 87300 | $33.15 | $65.00 | $11.74 – $40.77 | 4 |
| Infect ag if hep delta agent CPT 87380 | not published | not published | $17.99 – $139.45 | 4 |
| Infect ag if influenza a CPT 87276 | $24.48 | $48.00 | $15.75 – $78.88 | 4 |
| Infect ag if influenza b CPT 87275 | $24.48 | $48.00 | $12.00 – $81.48 | 4 |
| Infect ag if legionella pneumophila CPT 87278 | $7.74 | $15.18 | $15.29 – $78.88 | 4 |
| Infect ag if nos ea CPT 87299 | not published | not published | $15.78 – $78.88 | 4 |
| Infect ag if pneumocystis carinii CPT 87281 | $63.19 | $123.90 | $11.74 – $81.48 | 4 |
| Infect ag if varicella zoster CPT 87290 | not published | not published | $13.15 – $78.88 | 4 |
| Infect ag na chlamydia trachomatis qnt CPT 87492 | not published | not published | $52.40 – $227.07 | 4 |
| Infect ag na hep b amp CPT 87516 | not published | not published | $34.39 – $298.03 | 4 |
| Infect ag na herpes simplex quant CPT 87530 | $82.88 | $162.50 | $41.98 – $227.07 | 4 |
| Infect ag na hpv high-risk types CPT 87624 | $265.20 | $520.00 | $34.39 – $221.22 | 4 |
| Infect ag na influenza r/amp 1st 2 types CPT 87502 | $556.92 | $1,092.00 | $93.88 – $567.00 | 4 |
| Infect ag na influenza revr/amp ea type CPT 87501 | not published | not published | $50.28 – $341.94 | 4 |
| Infect ag na orthopoxvirus amp prb each CPT 87593 | $24.99 | $49.00 | $50.28 – $102.34 | 3 |
| Infect ag na resp virus 12-25 targets CPT 87633 | $2,964.63 | $5,813.00 | $408.44 – $2,772.42 | 4 |
| Infect ag phenotype na hiv-1 1-10 drugs CPT 87903 | not published | not published | $478.89 – $4,285.88 | 4 |
| Infect ag phenotype na hiv-1 ea addl drg CPT 87904 | not published | not published | $25.55 – $228.61 | 4 |
| Infectious agent antigen immunoassay direct optical observation sars-cov-2 CPT 87811 | $84.15 | $165.00 | $34.98 – $82.96 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | $152.49 | $299.00 | $11.74 – $78.88 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans CPT 87327 | not published | not published | $13.15 – $81.48 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step cryptosporidium CPT 87328 | $122.40 | $240.00 | $13.54 – $78.88 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | $154.53 | $303.00 | $11.74 – $81.84 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $73.95 | $145.00 | $14.09 – $139.92 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $159.63 | $313.00 | $10.12 – $87.69 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 | $12.46 | $24.44 | $10.12 – $90.58 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $205.53 | $403.00 | $23.60 – $165.15 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | $140.25 | $275.00 | $11.74 – $78.88 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 | $76.50 | $150.00 | $11.74 – $78.88 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin CPT 87427 | not published | not published | $11.74 – $81.48 | 4 |
| Infectious agent nucleic acid amplified probe CPT 87798 | $557.43 | $1,093.00 | $34.39 – $298.03 | 4 |
| Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 | $319.77 | $627.00 | $34.39 – $298.03 | 4 |
| Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 | $729.30 | $1,430.00 | $36.52 – $361.73 | 4 |
| Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets CPT 87483 | $1,045.50 | $2,050.00 | $408.44 – $2,932.19 | 4 |
| Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 | $72.68 | $142.50 | $34.39 – $298.03 | 4 |
| Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus CPT 87641 | $279.48 | $548.00 | $34.39 – $301.34 | 4 |
| Infectious agent nucleic acid amplified probe mycobacteria tuberculosis CPT 87556 | $810.90 | $1,590.00 | $40.85 – $298.03 | 4 |
| Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 | $319.77 | $627.00 | $34.39 – $298.03 | 4 |
| Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 | $105.06 | $206.00 | $50.28 – $303.18 | 4 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 | $669.63 | $1,313.00 | $139.78 – $374.32 | 4 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv CPT 87637 | $169.32 | $332.00 | $139.78 – $374.32 | 4 |
| Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 | $182.07 | $357.00 | $34.39 – $298.03 | 4 |
| Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 | $216.75 | $425.00 | $34.39 – $177.32 | 4 |
| Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae CPT 87494 | $104.04 | $204.00 | $68.78 – $70.18 | 2 |
| Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance CPT 87564 | not published | not published | $75.23 – $153.54 | 4 |
| Infectious agent nucleic acid joint space pathogens multiplex amplified probe >= 26 targets CPT 87627 | not published | not published | $666.17 – $679.77 | 2 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 | not published | not published | $408.44 – $2,627.42 | 4 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets CPT 87505 | not published | not published | $125.72 – $808.72 | 4 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets CPT 87506 | $1,319.37 | $2,587.00 | $257.73 – $1,345.47 | 4 |
| Infectious agent nucleic acid quantification bk virus CPT 87799 | $190.74 | $374.00 | $41.98 – $227.07 | 4 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | $165.75 | $325.00 | $41.98 – $227.07 | 4 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | $215.22 | $422.00 | $41.98 – $227.07 | 4 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | $150.45 | $295.00 | $83.40 – $227.07 | 4 |
| Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 | $837.42 | $1,642.00 | $139.78 – $853.33 | 4 |
| Infliximab 100 mg intravenous solution HCPCS J1745 | $2,634.48 | $5,165.64 | $30.42 – $85.04 | 4 |
| Infliximab-axxq 100 mg intravenous solution HCPCS Q5121 | $1,166.66 | $2,287.56 | $27.48 – $71.54 | 4 |
| Infliximab-dyyb 100 mg intravenous solution HCPCS Q5103 | $1,357.01 | $2,660.81 | $25.51 – $135.39 | 4 |
| Influenza dna amp prob addl CPT 87503 | not published | not published | $28.64 – $138.32 | 4 |
| Influenza virus vaccine, inact hemagglutinin tiv pf inj CPT 90673 | not published | not published | $46.65 – $179.50 | 2 |
| Influenza virus vaccine, live trivalent intranasal CPT 90660 | not published | not published | $62.07 – $76.23 | 2 |
| Inf lwr xtr fscl pln blk uni w/wo image CPT 64474 | not published | not published | $691.00 – $1,716.00 | 2 |
| Infratemporal approach/skull CPT 61591 | not published | not published | $5,530.00 – $12,568.00 | 3 |
| Infratemporal approach/skull CPT 61590 | not published | not published | $5,530.00 – $12,568.00 | 3 |
| Inf thrc fascial pln blk bi w/wo image CPT 64469 | not published | not published | $691.00 – $1,716.00 | 2 |
| Inf thrc fascial pln blk uni w/wo image CPT 64467 | not published | not published | $691.00 – $1,716.00 | 2 |
| Infuse radioactive materials CPT 77750 | not published | not published | $334.73 – $547.63 | 3 |
| Ingest challenge ea addl 60 min CPT 95079 | not published | not published | $552.58 – $552.58 | 1 |
| Ingest challenge ini 120 min CPT 95076 | not published | not published | $519.24 – $806.95 | 3 |
| Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis CPT 94642 | not published | not published | $304.70 – $337.09 | 3 |
| Initial care training 30 m HCPCS G0539 | not published | not published | $44.96 – $45.88 | 2 |
| Initial foot exam pt lops HCPCS G0245 | not published | not published | $185.25 – $189.04 | 2 |
| Initiation & management bipap/cpap initial day CPT 94660 | $3,508.80 | $6,880.00 | $304.70 – $447.11 | 3 |
| Init/sub psych care m 1st 30 HCPCS G2214 | not published | not published | $141.36 – $144.24 | 2 |
| Inj, abilify asimtufii, 1 mg HCPCS J0402 | not published | not published | $5.90 – $12.62 | 4 |
| Inj, abilify maintena, 1 mg HCPCS J0401 | not published | not published | $5.19 – $15.11 | 4 |
| Inj acetaminoph 10mg/ibu 3mg HCPCS J0138 | not published | not published | $0.09 – $0.47 | 4 |
| Inj, acetaminophen (b braun) HCPCS J0136 | $84.15 | $165.00 | $0.10 – $0.19 | 3 |
| Inj acetaminophen -fresenius HCPCS J0134 | not published | not published | $0.10 – $0.19 | 3 |
| Inj, acetaminophen (hikma) HCPCS J0137 | not published | not published | $0.05 – $0.19 | 3 |
| Inj. acthar gel to 40 units HCPCS J0801 | not published | not published | $4,012.37 – $8,370.87 | 4 |
| Inj, adalimumab, 1 mg HCPCS J0139 | $7,730.04 | $15,156.95 | $197.22 – $197.22 | 1 |
| Inj adalimumab-ryvk, 1 mg HCPCS Q5142 | not published | not published | $18.55 – $22.60 | 2 |
| Inj, adstiladrin, per tx dos HCPCS J9029 | not published | not published | $62,996.65 – $135,956.56 | 4 |
| Inj, aducanumab-avwa, 2 mg HCPCS J0172 | not published | not published | $11.96 – $16.04 | 3 |
| Inj, adzynma, 10 iu HCPCS J7171 | not published | not published | $34.86 – $74.22 | 4 |
| Inj, aflibercept-ayyh, 1 mg HCPCS Q5147 | not published | not published | $804.97 – $1,711.10 | 3 |
| Inj, aflibercept hd, 1 mg HCPCS J0177 | not published | not published | $295.15 – $690.54 | 4 |
| Inj, afstyla, 1 i.u HCPCS J7210 | not published | not published | $1.54 – $3.25 | 4 |
| Inj allopurinol sodium 1 mg HCPCS J0206 | not published | not published | $3.73 – $9.74 | 4 |
| Inj, alyglo, 500 mg HCPCS J1552 | not published | not published | $120.66 – $296.94 | 4 |
| Inj alymsys 10 mg HCPCS Q5126 | not published | not published | $50.56 – $102.84 | 4 |
| Inj, amisulpride, 1 mg HCPCS J0184 | not published | not published | $9.37 – $19.59 | 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.