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 |
|---|---|---|---|---|
| Inj, pemivibart, 4500 mg HCPCS Q0224 | not published | not published | $8,262.96 – $14,154.53 | 2 |
| Inj, pemrydi rtu, 10 mg HCPCS J9324 | not published | not published | $69.07 – $174.28 | 4 |
| Inj perflexane lip micros,ml HCPCS Q9955 | not published | not published | $102.93 – $157.65 | 2 |
| Inj peritoneal venous shunt CPT 49427 | $619.65 | $1,215.00 | $1,716.00 – $12,908.00 | 3 |
| Inj., perseris, 0.5 mg HCPCS J2798 | $2,698.44 | $5,291.06 | $11.93 – $26.12 | 4 |
| Inj plasminogen tvmh 1mg HCPCS J2998 | not published | not published | $37.63 – $69.62 | 4 |
| Inj., plazomicin, 5 mg HCPCS J0291 | not published | not published | $3.44 – $7.68 | 4 |
| Inj pozelimab-bbfg, 1 mg HCPCS J9376 | not published | not published | $89.90 – $223.28 | 4 |
| Inj proc ankle arthr CPT 27648 | not published | not published | $347.67 – $4,042.00 | 3 |
| Inj proc elbow arthro CPT 24220 | $219.30 | $430.00 | $459.78 – $4,042.00 | 3 |
| Inj proc for lymphang CPT 38790 | $1,363.74 | $2,674.00 | $557.81 – $4,042.00 | 3 |
| Inj proc lumbr disk ea lvl CPT 62290 | not published | not published | $1,172.33 – $4,042.00 | 3 |
| Inj proc myelogram lumbar CPT 62284 | $327.42 | $642.00 | $596.84 – $4,042.00 | 3 |
| Inj proc sialogram CPT 42550 | not published | not published | $462.08 – $4,042.00 | 3 |
| Inj progesterone per 50 mg HCPCS J2675 | $84.15 | $165.00 | $1.32 – $4.64 | 3 |
| Inj prohance multipack HCPCS A9576 | not published | not published | $3.07 – $8.24 | 2 |
| Inj protirelin per 250 mcg HCPCS J2725 | not published | not published | $30.60 – $30.60 | 1 |
| Inj recombin esperoct per iu HCPCS J7204 | not published | not published | $2.18 – $4.60 | 4 |
| Inj, releuko 1 mcg HCPCS Q5125 | $519.53 | $1,018.69 | $0.31 – $0.92 | 4 |
| Inj retacrit esrd on dialysi HCPCS Q5105 | not published | not published | $1.41 – $1.58 | 3 |
| Inj retro urethrocysto CPT 51610 | $252.45 | $495.00 | $494.91 – $4,042.00 | 3 |
| Inj, rimabotulinumtoxinb HCPCS J0587 | not published | not published | $12.33 – $27.95 | 4 |
| Inj roctavian ml 2x10^13vc g HCPCS J1412 | not published | not published | $12,302.64 – $25,816.79 | 4 |
| Inj., rolapitant, 0.5 mg HCPCS J2797 | not published | not published | $1.30 – $1.30 | 1 |
| Inj romidepsin non-lyo 0.1mg HCPCS J9318 | not published | not published | $27.95 – $61.32 | 4 |
| Inj, rykindo, 0.5 mg HCPCS J2801 | not published | not published | $12.77 – $28.01 | 4 |
| Inj scleros sol mult veins CPT 36471 | not published | not published | $565.65 – $4,042.00 | 5 |
| Inj scleros sol sgl vein CPT 36470 | not published | not published | $565.65 – $4,042.00 | 5 |
| Inj, sculptra, 0.5mg HCPCS Q2028 | not published | not published | $0.93 – $2.16 | 4 |
| Inj sebelipase alfa 1 mg HCPCS J2840 | not published | not published | $529.37 – $1,158.21 | 4 |
| Inj secretin synthetic human HCPCS J2850 | not published | not published | $30.32 – $91.53 | 4 |
| Inj secukinumab intrav 1mg HCPCS J3247 | not published | not published | $17.68 – $38.12 | 4 |
| Inj, sezaby, 1 mg HCPCS J2561 | not published | not published | $1.11 – $2.28 | 4 |
| Inj, spesolimab-sbzo, 1 mg HCPCS J1747 | not published | not published | $64.41 – $132.07 | 4 |
| Inj(s) sclerosant spider veins limb/trunk CPT 36468 | not published | not published | $565.65 – $4,042.00 | 5 |
| Inj sulf hexa lipid microsph HCPCS Q9950 | not published | not published | $37.45 – $41.45 | 3 |
| Inj, susvimo 0.1 mg HCPCS J2779 | not published | not published | $74.68 – $171.44 | 4 |
| Inj, sutimlimab-jome, 10 mg HCPCS J1302 | not published | not published | $19.25 – $38.98 | 4 |
| Inj. tagraxofusp-erzs 10 mcg HCPCS J9269 | not published | not published | $350.13 – $727.84 | 4 |
| Inj, taliglucerace alfa 10 u HCPCS J3060 | not published | not published | $39.84 – $87.38 | 4 |
| Inj teclistamab cqyv 0.5 mg HCPCS J9380 | not published | not published | $33.81 – $69.70 | 3 |
| Inj tedizolid phosphate HCPCS J3090 | not published | not published | $1.67 – $3.87 | 4 |
| Inj teplizumab mzwv 5 mcg HCPCS J9381 | not published | not published | $37.63 – $80.22 | 4 |
| Inj. teprotumumab-trbw 10 mg HCPCS J3241 | not published | not published | $360.55 – $758.00 | 4 |
| Inj testostero enanthate 1mg HCPCS J3121 | $85.68 | $168.00 | $0.09 – $0.11 | 3 |
| Inj, testosterone, azmiro HCPCS J1072 | not published | not published | $0.13 – $2.77 | 3 |
| Inj testosterone cypionate HCPCS J1071 | not published | not published | $0.06 – $0.09 | 3 |
| Inj theophylline per 40 mg HCPCS J2810 | not published | not published | $0.37 – $2.26 | 2 |
| Inj thrc fascial pln blk bi w/wo image CPT 64468 | not published | not published | $691.00 – $1,716.00 | 2 |
| Inj thrc fascial pln blk uni w/wo image CPT 64466 | not published | not published | $691.00 – $1,716.00 | 2 |
| Inj. tigecycline (accord) HCPCS J3244 | not published | not published | $3.62 – $7.27 | 2 |
| Inj., tildrakizumab, 1 mg HCPCS J3245 | not published | not published | $115.84 – $1,327.61 | 4 |
| Inj, tislelizumab-jsgr HCPCS J9329 | not published | not published | $57.10 – $1,210.00 | 4 |
| Inj tofersen intrathec 1 mg HCPCS J1304 | not published | not published | $156.81 – $333.98 | 4 |
| Inj, tofidence, 1 mg HCPCS Q5133 | not published | not published | $5.15 – $12.84 | 4 |
| Inj travoprost intra impl HCPCS J7355 | not published | not published | $192.94 – $417.98 | 4 |
| Inj triamcinolone ace X-ray 1mg HCPCS J3304 | not published | not published | $18.26 – $38.72 | 4 |
| Inj triferic avnu 0.1mg iron HCPCS J1445 | not published | not published | $0.28 – $0.28 | 1 |
| Inj., triluron, 1 mg HCPCS J7332 | not published | not published | $10.33 – $34.99 | 4 |
| Inj., triptorelin X-ray 3.75 mg HCPCS J3316 | not published | not published | $3,649.28 – $7,537.99 | 4 |
| Inj, trivisc 1 mg HCPCS J7329 | not published | not published | $3.21 – $12.02 | 4 |
| Inj, tyenne, 1 mg HCPCS Q5135 | not published | not published | $4.35 – $8.75 | 4 |
| Inj, uzedy, 1 mg HCPCS J2799 | not published | not published | $24.65 – $52.93 | 4 |
| Inj, vancomycin hcl (mylan) HCPCS J3371 | not published | not published | $11.50 – $13.57 | 3 |
| Inj, vancomycin hcl (xellia) HCPCS J3372 | not published | not published | $10.94 – $14.06 | 3 |
| Inj vasopressin (am reg) 1 u HCPCS J2599 | $84.15 | $165.00 | $2.66 – $3.62 | 3 |
| Inj, vasopressin (baxter) HCPCS J2601 | $190.33 | $373.20 | $1.50 – $7.53 | 4 |
| Inj, vegzelma, 10 mg HCPCS Q5129 | not published | not published | $33.96 – $103.37 | 4 |
| Inj velmanase alfa-tycv 1 mg HCPCS J0217 | not published | not published | $455.93 – $956.71 | 4 |
| Inj., vestronidase alfa-vjbk HCPCS J3397 | not published | not published | $274.55 – $700.73 | 4 |
| Inj. viltolarsen HCPCS J1427 | not published | not published | $80.69 – $145.51 | 2 |
| Inj vocal cord bulking agent HCPCS L8607 | not published | not published | $132.63 – $132.63 | 1 |
| Inj w/fluor eval cv device CPT 36598 | $232.05 | $455.00 | $295.97 – $4,042.00 | 5 |
| Inj. xembify, 100 mg HCPCS J1558 | not published | not published | $15.06 – $30.70 | 4 |
| Inj xipere 1 mg HCPCS J3299 | not published | not published | $46.82 – $103.69 | 4 |
| Inj., yutiq, 0.01 mg HCPCS J7314 | not published | not published | $519.29 – $1,127.83 | 4 |
| Inner skull vessel surgery CPT 61702 | not published | not published | $5,530.00 – $12,568.00 | 3 |
| Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln HCPCS J9229 | not published | not published | $2,760.43 – $5,714.98 | 4 |
| Ins cath ren art 1st bi CPT 36252 | $4,624.68 | $9,068.00 | $2,513.33 – $11,377.00 | 4 |
| Ins cath ren art 1st uni CPT 36251 | $7,860.12 | $15,412.00 | $1,929.81 – $11,377.00 | 4 |
| Ins cath ren art 2nd+ bi CPT 36254 | not published | not published | $2,892.91 – $11,377.00 | 4 |
| Ins cath ren art 2nd+ uni CPT 36253 | $10,545.27 | $20,677.00 | $2,681.54 – $15,575.00 | 4 |
| Ins cerv dilator (sep proc) CPT 59200 | $1,602.42 | $3,142.00 | $424.02 – $4,042.00 | 5 |
| Ins device for right guide open CPT 49412 | not published | not published | $6,732.00 – $9,773.00 | 2 |
| Insemination of oocytes CPT 89268 | not published | not published | $237.06 – $6,499.57 | 4 |
| Insert abdomen-venous drain CPT 49425 | not published | not published | $2,238.00 – $15,202.00 | 4 |
| Insert and remove bone pin CPT 20650 | $6,447.42 | $12,642.00 | $3,423.00 – $11,377.00 | 5 |
| Insert ant drainage device CPT 66183 | not published | not published | $2,995.00 – $11,377.00 | 5 |
| Insert balloon device CPT 33973 | not published | not published | $6,732.00 – $9,773.00 | 2 |
| Insert brain-fluid device 61215 CPT 61215 | not published | not published | $3,423.00 – $12,460.49 | 5 |
| Insert cannula hemo oth 36815 CPT 36815 | not published | not published | $3,423.00 – $15,575.00 | 5 |
| Insert cannula vein-to-vein hemodialysis CPT 36800 | not published | not published | $3,423.00 – $15,575.00 | 5 |
| Insert cath pleura with image CPT 32557 | $3,222.69 | $6,319.00 | $2,190.38 – $4,042.00 | 5 |
| Insert cath pleura without image CPT 32556 | $3,627.63 | $7,113.00 | $2,238.00 – $4,737.00 | 5 |
| Insert cv cath inf & sup app HCPCS C9780 | not published | not published | $11,236.89 – $20,488.00 | 3 |
| Insert drug del implant, >=4 HCPCS G0516 | not published | not published | $621.60 – $1,716.00 | 3 |
| Insert drug delivery implant CPT 11981 | not published | not published | $185.13 – $1,716.00 | 4 |
| Insert electrodes for eeg CPT 95830 | not published | not published | $4,042.00 – $4,042.00 | 1 |
| Insert epicard eltrd endo 33203 CPT 33203 | not published | not published | $4,042.00 – $6,732.00 | 2 |
| Insert epicardial lead open 33202 CPT 33202 | not published | not published | $6,732.00 – $9,773.00 | 2 |
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.