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 |
|---|---|---|---|---|
| Injection into brain canal CPT 61026 | not published | not published | $982.21 – $4,042.00 | 5 |
| Injection into brain canal CPT 61055 | not published | not published | $427.11 – $4,042.00 | 5 |
| Injection into hemorrhoid(s) CPT 46500 | $1,799.79 | $3,529.00 | $1,294.00 – $4,042.00 | 5 |
| Injection into spinal artery CPT 62294 | not published | not published | $1,230.71 – $5,318.00 | 5 |
| Injection into vocal cord CPT 31513 | not published | not published | $544.23 – $4,042.00 | 5 |
| Injection intraop add-on CPT 48400 | not published | not published | $2,238.00 – $6,732.00 | 3 |
| Injection, isavuconazonium HCPCS J1833 | not published | not published | $0.93 – $2.13 | 4 |
| Injection jaw joint x-ray CPT 21116 | not published | not published | $277.72 – $4,042.00 | 3 |
| Injection jugular CPT 36299 | not published | not published | $1,716.00 – $1,716.00 | 1 |
| Injection, khapzory, 0.5 mg HCPCS J0642 | not published | not published | $2.35 – $2.89 | 3 |
| Injection, necitumumab, 1 mg HCPCS J9295 | not published | not published | $5.62 – $12.32 | 4 |
| Injection of HIV prep drug HCPCS G0012 | not published | not published | $100.19 – $102.23 | 2 |
| Injection of sinus tract CPT 20500 | $2,178.72 | $4,272.00 | $691.00 – $4,737.00 | 5 |
| Injection,onabotulinumtoxina HCPCS J0585 | $1,771.49 | $3,473.50 | $6.31 – $13.93 | 4 |
| Injection, pentamidine iseth HCPCS S0080 | $307.06 | $602.07 | $60.81 – $60.81 | 1 |
| Injection, peramivir HCPCS J2547 | not published | not published | $1.64 – $3.61 | 4 |
| Injection, piperacillin sodi HCPCS S0081 | not published | not published | $5.59 – $5.59 | 1 |
| Injection px peyronie ds CPT 54200 | not published | not published | $347.66 – $4,042.00 | 5 |
| Injection radioactive tracer sentinel node (both sides) CPT 38792 | $420.24 | $824.00 | $273.28 – $4,042.00 | 4 |
| Injection, renflexis HCPCS Q5104 | $1,445.21 | $2,833.75 | $26.27 – $107.76 | 4 |
| Injection, ruconest HCPCS J0596 | not published | not published | $35.94 – $74.71 | 4 |
| Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides) HCPCS G0260 | not published | not published | $691.00 – $4,042.00 | 5 |
| Injection(s) anesthetic agent(s) and/or steroid femoral nerve left CPT 64447 | $1,102.11 | $2,161.00 | $982.21 – $4,042.00 | 5 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $892.50 | $1,750.00 | $982.21 – $4,042.00 | 5 |
| Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 | $2,984.52 | $5,852.00 | $1,230.71 – $4,042.00 | 5 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level CPT 64491 | $2,317.95 | $4,545.00 | $1,716.00 – $12,908.00 | 4 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level CPT 64490 | $2,317.95 | $4,545.00 | $1,230.71 – $4,042.00 | 5 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance CPT 64494 | $2,317.95 | $4,545.00 | $1,716.00 – $12,908.00 | 4 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 | $2,317.95 | $4,545.00 | $1,230.71 – $4,042.00 | 5 |
| Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance CPT 62321 | $2,984.52 | $5,852.00 | $982.21 – $4,042.00 | 5 |
| Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 | $2,984.52 | $5,852.00 | $982.21 – $4,042.00 | 5 |
| Injection, siltuximab HCPCS J2860 | not published | not published | $122.78 – $351.25 | 4 |
| Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 | $1,649.34 | $3,234.00 | $427.11 – $4,042.00 | 5 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $2,139.45 | $4,195.00 | $427.11 – $4,042.00 | 5 |
| Injection(s) trigger point(s) single/multiple >= 3 muscle(s) CPT 20553 | $2,069.58 | $4,058.00 | $427.11 – $4,042.00 | 5 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug CPT 96375 | $196.35 | $385.00 | $65.16 – $66.49 | 2 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $110.16 | $216.00 | not published | 0 |
| Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug CPT 96374 | $391.68 | $768.00 | $295.97 – $302.01 | 2 |
| Injection therapeutic/prophylactic/diagnostic subcutaneous/im CPT 96372 | $118.83 | $233.00 | $100.19 – $102.23 | 2 |
| Injection, ticarcillin disod HCPCS S0040 | not published | not published | $20.08 – $20.08 | 1 |
| Injection torsemide 10 mg/ml HCPCS J3265 | not published | not published | $4.73 – $4.73 | 1 |
| Injection treatment of eye CPT 66020 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Injection treatment of eye CPT 66030 | $6,547.89 | $12,839.00 | $2,238.00 – $4,737.00 | 5 |
| Injection treatment of nerve CPT 64605 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Injection treatment of nerve CPT 64610 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Injection treatment of nerve CPT 64681 | not published | not published | $1,230.71 – $4,042.00 | 5 |
| Injection treatment of nose CPT 30200 | not published | not published | $750.46 – $4,042.00 | 5 |
| Inject sacroiliac joint CPT 27096 | $3,291.54 | $6,454.00 | $473.17 – $4,042.00 | 4 |
| Inject/treat eye socket CPT 67500 | not published | not published | $441.66 – $4,042.00 | 5 |
| Inject/treat eye socket CPT 67505 | not published | not published | $441.66 – $4,042.00 | 5 |
| Inject/treat eye socket CPT 67515 | not published | not published | $441.66 – $4,042.00 | 5 |
| Inj, eculizumab-aagh, 2 mg HCPCS Q5151 | not published | not published | $31.29 – $78.54 | 3 |
| Inj, eculizumab-aeeb, 2 mg HCPCS Q5152 | not published | not published | $40.95 – $100.99 | 3 |
| Inj efgart-alfa 2mg hya-qvfc HCPCS J9334 | not published | not published | $33.64 – $71.75 | 4 |
| Inj eflapegrastim-xnst 0.1mg HCPCS J1449 | not published | not published | $38.18 – $48.78 | 4 |
| Inj., emapalumab-lzsg, 1 mg HCPCS J9210 | not published | not published | $376.45 – $820.23 | 4 |
| Inj., emicizumab-kxwh 0.5 mg HCPCS J7170 | not published | not published | $54.53 – $111.76 | 4 |
| Inj epidural sgl cerv-thor without img CPT 62320 | $2,984.52 | $5,852.00 | $982.21 – $4,042.00 | 5 |
| Inj epidural sgl lumb-sacral without img CPT 62322 | $2,984.52 | $5,852.00 | $1,230.71 – $4,042.00 | 5 |
| Inj, epinephrine (belcher) HCPCS J0173 | not published | not published | $1.58 – $4.84 | 3 |
| Inj., eravacycline, 1 mg HCPCS J0122 | not published | not published | $1.26 – $2.60 | 4 |
| Inj, erzofri, 1 mg HCPCS J2428 | not published | not published | $14.20 – $36.87 | 3 |
| Inj, etelcalcetide, 0.1 mg HCPCS J0606 | not published | not published | $2.31 – $10.64 | 4 |
| Inj, eteplirsen, 10 mg HCPCS J1428 | not published | not published | $164.16 – $412.80 | 4 |
| Inj, evinacumab-dgnb, 5mg HCPCS J1305 | not published | not published | $193.68 – $400.57 | 4 |
| Inj., evomela, 1 mg HCPCS J9246 | not published | not published | $19.04 – $57.23 | 4 |
| Inj, exagamglogene autotem HCPCS J3392 | not published | not published | $2,285,360.00 – $5,013,800.00 | 3 |
| Inj, factor x, (human), 1iu HCPCS J7175 | not published | not published | $9.75 – $20.49 | 4 |
| Inj, faricimab-svoa, 0.1mg HCPCS J2777 | not published | not published | $32.21 – $74.65 | 4 |
| Inj fe-based mr contrast,1ml HCPCS Q9953 | not published | not published | $38.49 – $111.35 | 2 |
| Inj. fe derisomaltose 10 mg HCPCS J1437 | not published | not published | $21.49 – $44.78 | 4 |
| Inj fensolvi 0.25 mg HCPCS J1951 | not published | not published | $137.89 – $288.66 | 4 |
| Inj ferric pyrophosphate cit HCPCS J1443 | not published | not published | $0.04 – $0.04 | 1 |
| Inj., fibryga, 1 mg HCPCS J7177 | not published | not published | $1.21 – $2.37 | 4 |
| Inj fluphenazine hcl 1.25 mg HCPCS J2679 | not published | not published | $13.72 – $15.37 | 3 |
| Inj, focinvez, 1mg HCPCS J1434 | not published | not published | $2.50 – $6.49 | 4 |
| Inj follitropin alfa 75 iu HCPCS S0126 | not published | not published | $105.68 – $105.68 | 1 |
| Inj follitropin beta 75 iu HCPCS S0128 | not published | not published | $233.35 – $233.35 | 1 |
| Inj for ext venography CPT 36005 | $2,601.00 | $5,100.00 | $1,716.00 – $12,908.00 | 3 |
| Inj for mammo ductogram CPT 19030 | $854.25 | $1,675.00 | $1,716.00 – $12,908.00 | 3 |
| Inj, fosaprepitant (teva) HCPCS J1456 | not published | not published | $0.04 – $2.87 | 4 |
| Inj fosnetupitant, palonoset HCPCS J1454 | not published | not published | $513.69 – $1,360.69 | 4 |
| Inj., fremanezumab-vfrm 1 mg HCPCS J3031 | not published | not published | $4.03 – $8.71 | 2 |
| Inj, fulvestrant (fresenius) HCPCS J9394 | not published | not published | $6.64 – $71.50 | 4 |
| Inj, fulvestrant (teva) HCPCS J9393 | not published | not published | $28.66 – $99.35 | 4 |
| Inj, gadopiclenol, 1 ml HCPCS A9573 | not published | not published | $7.46 – $15.80 | 2 |
| Inj, ganciclovir (exela) HCPCS J1574 | not published | not published | $71.50 – $129.00 | 2 |
| Inj ganirelix acetat 250 mcg HCPCS S0132 | not published | not published | $262.48 – $262.48 | 1 |
| Inj gemcitabine hcl (accord) HCPCS J9196 | not published | not published | $15.86 – $18.60 | 3 |
| Inj givosiran 0.5 mg HCPCS J0223 | not published | not published | $118.56 – $250.41 | 4 |
| Inj glofitamab gxbm, 2.5 mg HCPCS J9286 | not published | not published | $2,783.86 – $5,961.52 | 4 |
| Inj glycopyrrolate fres kabi HCPCS J1598 | not published | not published | $3.32 – $3.62 | 3 |
| Inj glycopyrrolate, glyrx-pf HCPCS J1597 | not published | not published | $2.32 – $4.21 | 2 |
| Inj golodirsen 10 mg HCPCS J1429 | not published | not published | $228.93 – $412.80 | 2 |
| Inj, granisetron, xr, 0.1 mg HCPCS J1627 | not published | not published | $3.80 – $11.37 | 4 |
| Inj., guselkumab, 1 mg HCPCS J1628 | not published | not published | $66.46 – $151.42 | 4 |
| Inj., haegarda 10 units HCPCS J0599 | not published | not published | $13.45 – $31.07 | 2 |
| Inj, hemgenix, per tx dose HCPCS J1411 | not published | not published | $3,617,621.00 – $7,923,323.34 | 3 |
| Inj heparin, pfizer, 1000u HCPCS J1643 | $84.15 | $165.00 | $0.46 – $6.32 | 3 |
| Inj. herceptin hylecta, 10mg HCPCS J9356 | not published | not published | $58.71 – $135.28 | 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.