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 |
|---|---|---|---|---|
| Io ga n-stim subsq w/reprog CPT 95982 | not published | not published | $51.93 – $181.99 | 3 |
| Ionm in operatng room 15 min CPT 95940 | not published | not published | $210.53 – $210.53 | 1 |
| Ionm remote/>1 pt or per hr CPT 95941 | not published | not published | $301.82 – $301.82 | 1 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | $180.03 | $353.00 | $0.56 – $0.88 | 2 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $112.91 | $221.40 | $0.30 – $0.56 | 2 |
| Io radiation tx management CPT 77469 | not published | not published | $1,786.79 – $1,786.79 | 1 |
| Io rad tx deliver by elctrns CPT 77425 | not published | not published | $885.71 – $10,457.69 | 3 |
| Io rad tx delivery by x-ray CPT 77424 | not published | not published | $10,248.54 – $10,457.69 | 2 |
| Ipilimumab 5 mg/ml intravenous solution (wrapper) HCPCS J9228 | not published | not published | $171.65 – $387.47 | 4 |
| Ipratropium bromide comp HCPCS J7645 | not published | not published | $0.09 – $0.09 | 1 |
| Ipratropium bromide non-comp HCPCS J7644 | $5.61 | $11.00 | $0.72 – $4.73 | 3 |
| Irinotecan 20 mg/ml intravenous solution (wrapper) HCPCS J9206 | $507.20 | $994.51 | $3.28 – $190.57 | 3 |
| Irinotecan liposomal 4.3 mg/ml intravenous HCPCS J9205 | not published | not published | $53.88 – $140.35 | 4 |
| Iron CPT 83540 | $119.34 | $234.00 | $6.34 – $56.84 | 4 |
| Iron binding capacity CPT 83550 | $196.86 | $386.00 | $8.57 – $60.03 | 4 |
| Iron dextran 50 mg/ml injection solution HCPCS J1750 | not published | not published | $17.74 – $37.04 | 4 |
| Iron stain peripheral blood CPT 85536 | not published | not published | $6.74 – $56.78 | 4 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $107.76 | $211.30 | $0.47 – $0.83 | 3 |
| Irradiation of blood product each unit reference CPT 86945 | not published | not published | $51.97 – $157.94 | 4 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $111.18 | $218.00 | $82.09 – $83.76 | 2 |
| Irrigation sphenoid sinus CPT 31002 | not published | not published | $2,158.97 – $4,737.00 | 5 |
| Irrigation vagina and/or appl medicament tx disease CPT 57150 | not published | not published | $82.09 – $1,716.00 | 4 |
| Isatuximab-irfc 20 mg/ml intravenous solution HCPCS J9227 | not published | not published | $81.91 – $169.55 | 4 |
| Island pedicle flap graft CPT 15740 | not published | not published | $2,870.98 – $4,737.00 | 5 |
| Ivc venogram s&i CPT 75825 | $4,012.17 | $7,867.00 | $1,051.88 – $4,434.05 | 4 |
| Ivig non-lyophilized, nos HCPCS J1599 | not published | not published | $81.51 – $81.51 | 1 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $118.83 | $233.00 | $100.19 – $102.23 | 2 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $50.49 | $99.00 | not published | 0 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $1,054.17 | $2,067.00 | $65.16 – $66.49 | 2 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $1,330.59 | $2,609.00 | $295.97 – $302.01 | 2 |
| IV inj ra drug dx study CPT 78808 | not published | not published | $296.62 – $589.01 | 4 |
| IV njx tst vasc flo flap/grf CPT 15860 | not published | not published | $621.60 – $4,042.00 | 5 |
| Ivp w/nephrotomography CPT 74415 | $1,004.19 | $1,969.00 | $244.06 – $529.12 | 4 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $1,020.51 | $2,001.00 | $244.06 – $422.41 | 4 |
| Ixabepilone 15 mg intravenous solution HCPCS J9207 | not published | not published | $91.62 – $292.85 | 4 |
| Jak2 targeted sequence analysis CPT 81279 | $199.92 | $392.00 | $181.50 – $551.52 | 4 |
| Jaw arthroscopy/surgery CPT 29800 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Jaw arthroscopy/surgery CPT 29804 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Jejunstmy tube plcmt CPT 44372 | not published | not published | $2,670.09 – $4,737.00 | 5 |
| John cunningham antibody CPT 86711 | $770.65 | $1,511.08 | $16.55 – $95.78 | 4 |
| J-tube placement CPT 44015 | not published | not published | $2,238.00 – $6,732.00 | 3 |
| Kafo femoral fx cast rigid HCPCS L2136 | $2,469.03 | $4,841.24 | not published | 0 |
| Keratomileusis CPT 65760 | not published | not published | $4,042.00 – $25,815.00 | 4 |
| Keratophakia CPT 65765 | not published | not published | $6,682.00 – $25,815.00 | 4 |
| Keratoprosthesis CPT 65770 | not published | not published | $6,682.00 – $20,596.66 | 5 |
| Kerecis marigen shld sq cm HCPCS A2019 | not published | not published | $173.16 – $1,517.15 | 3 |
| Ketamine and metabolite screen - quest CPT 80357 | $5.56 | $10.91 | $0.07 – $112.21 | 2 |
| Ketogenic steroids fract CPT 83582 | not published | not published | $15.16 – $124.38 | 4 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $168.81 | $331.00 | $8.01 – $71.32 | 4 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $84.15 | $165.00 | $0.33 – $12.06 | 4 |
| Kidney endoscopy CPT 50551 | not published | not published | $2,238.00 – $7,613.01 | 5 |
| Kidney endoscopy CPT 50553 | not published | not published | $2,238.00 – $7,613.01 | 5 |
| Kidney endoscopy CPT 50570 | not published | not published | $2,238.00 – $5,004.98 | 5 |
| Kidney endoscopy CPT 50575 | not published | not published | $2,238.00 – $11,377.00 | 5 |
| Kidney endoscopy & biopsy CPT 50555 | not published | not published | $2,238.00 – $13,172.24 | 5 |
| Kidney endoscopy & biopsy CPT 50574 | not published | not published | $2,238.00 – $5,004.98 | 5 |
| Kidney endoscopy & treatment CPT 50557 | not published | not published | $2,238.00 – $13,172.24 | 5 |
| Kidney endoscopy & treatment CPT 50561 | not published | not published | $2,238.00 – $7,613.01 | 5 |
| Kidney endoscopy & treatment CPT 50576 | not published | not published | $2,238.00 – $13,172.24 | 5 |
| Kidney endoscopy & treatment CPT 50580 | not published | not published | $2,238.00 – $7,613.01 | 5 |
| Kidney function study CPT 78725 | $1,640.67 | $3,217.00 | $416.03 – $589.01 | 4 |
| Kidney imaging (3d) CPT 78710 | not published | not published | $1,484.62 – $1,484.62 | 1 |
| Kidney imaging morphology CPT 78700 | not published | not published | $556.27 – $713.89 | 4 |
| Kidney imag w/bld flow multi CPT 78709 | not published | not published | $755.17 – $1,122.95 | 4 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $2,353.65 | $4,615.00 | $755.17 – $1,114.14 | 4 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $2,656.08 | $5,208.00 | $145.47 – $496.21 | 4 |
| Kit case 4.2mm spinejack HCPCS C1062 | not published | not published | $691.00 – $5,318.00 | 2 |
| Kit cath f 8f w/glv + wipe ster HCPCS A4353 | $11.53 | $22.60 | not published | 0 |
| Kit cath ivl 2.5x40mm 135cm shockwave s4 HCPCS C1761 | $14,621.70 | $28,670.00 | not published | 0 |
| Kit gene analys d816 variant CPT 81273 | not published | not published | $122.37 – $818.24 | 4 |
| Kit hfx iq ipg bundle HCPCS C1822 | $46,206.00 | $90,600.00 | not published | 0 |
| Kit ipg optimizer smart HCPCS C1824 | $79,825.20 | $156,520.00 | not published | 0 |
| Kit lead specify 5-6-5 HCPCS C1778 | $57,757.50 | $113,250.00 | not published | 0 |
| Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set HCPCS C1878 | $2,369.05 | $4,645.20 | not published | 0 |
| Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm HCPCS Q4105 | $8,207.02 | $16,092.19 | $17.90 – $176.69 | 4 |
| Kit sound processor cochlear osia 2 HCPCS L8691 | $17,525.72 | $34,364.16 | not published | 0 |
| Kit tissue closure sealant adhesive air leak progel 4 ml pleura HCPCS C2615 | $3,212.95 | $6,299.90 | not published | 0 |
| Knee Arthroscopy (Cartilage Repair) CPT 29877 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Knee arthroscopy/drainage CPT 29871 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Knee arthroscopy dx CPT 29870 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Knee Arthroscopy (Meniscus Repair) CPT 29881 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29850 | not published | not published | $2,237.46 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29851 | not published | not published | $2,237.46 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29873 | not published | not published | $4,552.87 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29874 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29875 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29876 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29879 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29880 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29882 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29883 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29884 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29886 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29887 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Knee arthroscopy/surgery CPT 29888 | not published | not published | $3,423.00 – $15,575.00 | 5 |
| Knee arthroscopy/surgery CPT 29889 | not published | not published | $3,423.00 – $18,229.15 | 5 |
| Knee MRI (with and without contrast) CPT 73723 | $8,086.05 | $15,855.00 | $485.45 – $6,272.09 | 4 |
| Knee MRI (with contrast) CPT 73722 | $5,237.70 | $10,270.00 | $1,089.31 – $3,388.28 | 4 |
| Knee MRI (without contrast) CPT 73721 | $4,281.45 | $8,395.00 | $332.01 – $2,769.47 | 4 |
| Knee X-ray CPT 73564 | $1,481.04 | $2,904.00 | $145.47 – $179.33 | 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.