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 |
|---|---|---|---|---|
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | not published | not published | $0.46 – $2.00 | 2 |
| Lomustine 10 mg HCPCS S0178 | not published | not published | $23.69 – $23.69 | 1 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | not published | not published | $217.06 – $455.80 | 4 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $85.68 | $168.00 | $3.13 – $15.95 | 3 |
| Lo sag rig pnl stays pre cst HCPCS L0626 | $541.88 | $1,062.50 | not published | 0 |
| Loudness balance test CPT 92562 | not published | not published | $300.45 – $306.58 | 2 |
| Low back disk surgery CPT 63030 | not published | not published | $6,682.00 – $15,575.00 | 5 |
| Low cost skin substitute app HCPCS C5271 | $1,258.68 | $2,468.00 | $691.00 – $15,202.00 | 4 |
| Low cost skin substitute app HCPCS C5273 | $3,738.30 | $7,330.00 | $691.00 – $15,202.00 | 4 |
| Low cost skin substitute app HCPCS C5275 | $1,258.68 | $2,468.00 | $691.00 – $15,202.00 | 4 |
| Low cost skin substitute app HCPCS C5277 | $1,258.68 | $2,468.00 | $691.00 – $15,202.00 | 4 |
| Low cost skin substitute app HCPCS C5272 | $1,497.87 | $2,937.00 | $1,716.00 – $12,908.00 | 2 |
| Low cost skin substitute app HCPCS C5274 | $699.72 | $1,372.00 | $1,716.00 – $12,908.00 | 2 |
| Low cost skin substitute app HCPCS C5276 | $1,497.87 | $2,937.00 | $1,716.00 – $12,908.00 | 2 |
| Low cost skin substitute app HCPCS C5278 | $1,284.69 | $2,519.00 | $1,716.00 – $12,908.00 | 2 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $4,337.04 | $8,504.00 | $244.06 – $2,193.13 | 4 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $4,098.36 | $8,036.00 | $485.45 – $1,760.02 | 4 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $3,692.91 | $7,241.00 | $145.47 – $1,472.15 | 4 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $8,460.39 | $16,589.00 | $485.45 – $5,473.94 | 4 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $5,156.10 | $10,110.00 | $485.45 – $3,335.22 | 4 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $4,764.93 | $9,343.00 | $332.01 – $3,081.68 | 4 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $1,280.61 | $2,511.00 | $145.47 – $179.33 | 4 |
| Lower jaw bone graft CPT 21215 | not published | not published | $6,682.00 – $12,568.00 | 5 |
| Low frequency non-thermal Ultrasound CPT 97610 | $268.26 | $526.00 | $279.18 – $284.87 | 2 |
| Loxapine for inhalation 1 mg HCPCS J2062 | not published | not published | $21.42 – $38.70 | 2 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $4,233.00 – $15,575.00 | 5 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $4,233.00 – $15,575.00 | 5 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $4,233.00 – $15,575.00 | 5 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $4,233.00 – $15,575.00 | 5 |
| Lso s/c shell/panel custom HCPCS L0640 | $3,133.33 | $6,143.79 | not published | 0 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $21.55 – $192.86 | 4 |
| Lumbar diskogram s&i CPT 72295 | not published | not published | $618.27 – $2,750.96 | 4 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $6,682.00 – $24,397.68 | 5 |
| Lumizyme injection HCPCS J0221 | not published | not published | $200.31 – $433.38 | 4 |
| Lung function test (mbc/mvv) CPT 94200 | $87.72 | $172.00 | $78.17 – $83.76 | 3 |
| Lung Function Test (Spirometry) CPT 94010 | $699.21 | $1,371.00 | $129.05 – $306.58 | 3 |
| Lung perfusion imaging CPT 78580 | $2,271.54 | $4,454.00 | $556.27 – $771.14 | 4 |
| Lung transplant double CPT 32853 | not published | not published | $5,530.00 – $12,568.00 | 3 |
| Lung transplant single CPT 32851 | not published | not published | $4,812.00 – $12,568.00 | 3 |
| Lung transplant with bypass CPT 32852 | not published | not published | $5,530.00 – $12,568.00 | 3 |
| Lung transplant with bypass CPT 32854 | not published | not published | $6,682.00 – $12,568.00 | 3 |
| Lung volume reduction 32491 CPT 32491 | not published | not published | $2,995.00 – $12,568.00 | 3 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | not published | not published | $207.86 – $440.84 | 4 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | not published | not published | $41.90 – $88.67 | 4 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | not published | not published | $313.55 – $636.94 | 4 |
| Lutetium lu 177 vipivotide HCPCS A9607 | $86,700.00 | $170,000.00 | $254.40 – $516.43 | 4 |
| Lvad shower bag heartmate HCPCS Q0501 | $1,586.30 | $3,110.40 | not published | 0 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $40.25 – $4,042.00 | 5 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $19.65 – $170.29 | 4 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | not published | not published | $2,238.00 – $15,575.00 | 5 |
| Lymphatics/lymph node imaging CPT 78195 | $2,357.73 | $4,623.00 | $755.17 – $1,023.51 | 4 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $35.83 – $479.49 | 4 |
| Lymphocyte transformation mitogen CPT 86353 | not published | not published | $48.05 – $430.21 | 4 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $185.72 – $379.02 | 4 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $46.64 – $315.88 | 4 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $872.87 – $1,360.71 | 4 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $1,360.71 – $2,609.81 | 4 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $1,531.83 – $4,393.52 | 4 |
| Lymph vessel x-ray trunk CPT 75807 | $4,628.76 | $9,076.00 | $1,523.74 – $4,434.05 | 4 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $750.46 – $4,042.00 | 5 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $2,908.69 – $6,732.00 | 5 |
| Lyumjev for insulin pump use HCPCS J1813 | not published | not published | $19.66 – $32.96 | 3 |
| Macro exam dissect molec study ea CPT 88387 | not published | not published | $14.44 – $52.02 | 3 |
| Macroscopic exam arthropod CPT 87168 | not published | not published | $4.18 – $37.46 | 4 |
| Macroscopic exam parasite CPT 87169 | not published | not published | $4.22 – $37.46 | 4 |
| Magnesium CPT 83735 | $162.18 | $318.00 | $6.57 – $58.44 | 4 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $145.35 | $285.00 | $0.56 – $1.05 | 3 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $332.01 – $2,781.05 | 4 |
| Makena, 10 mg HCPCS J1726 | not published | not published | $29.71 – $43.77 | 2 |
| Malaria antibody CPT 86750 | not published | not published | $12.93 – $115.75 | 4 |
| Male sling procedure CPT 53440 | not published | not published | $2,995.00 – $20,488.00 | 5 |
| Mammosite ced HCPCS C1728 | $8,639.40 | $16,940.00 | not published | 0 |
| Management of liver hemorrhage 47361 CPT 47361 | not published | not published | $4,233.00 – $9,773.00 | 3 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $691.00 – $4,042.00 | 5 |
| Manipulate wrist w/anesthes CPT 25259 | $3,107.43 | $6,093.00 | $2,237.46 – $4,737.00 | 5 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $389.64 | $764.00 | $109.19 – $188.91 | 3 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $474.30 | $930.00 | $177.02 – $188.91 | 3 |
| Manipulation of hip joint CPT 27275 | not published | not published | $2,237.46 – $4,737.00 | 5 |
| Manipulation of spine CPT 22505 | not published | not published | $2,237.46 – $4,737.00 | 5 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $343.23 – $4,042.00 | 5 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | not published | not published | $4.53 – $6.03 | 3 |
| Mannitol for inhaler HCPCS J7665 | not published | not published | $2.54 – $6.68 | 2 |
| Manual diff wbc count b-coat CPT 85009 | not published | not published | $4.97 – $32.62 | 4 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | not published | not published | $346.60 – $346.60 | 1 |
| Mapping io sentinel lymph node CPT 38900 | not published | not published | $1,716.00 – $12,908.00 | 3 |
| Map tachycard site(s) CPT 93609 | not published | not published | $1,716.00 – $25,815.00 | 3 |
| Margetuximab-cmkb 25 mg/ml intravenous solution HCPCS J9353 | not published | not published | $52.21 – $104.34 | 4 |
| Marker biop eviva buckle ss HCPCS A4648 | $8,285.84 | $16,246.75 | not published | 0 |
| Marker lymphatic sentimag magtrace 10 vial HCPCS A9697 | $2,986.07 | $5,855.04 | $1,228.92 – $2,446.61 | 3 |
| Marsupialization liver lesion 47300 CPT 47300 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Mastectomy partial CPT 19301 | not published | not published | $3,423.00 – $6,732.00 | 5 |
| Mast mod rad CPT 19307 | not published | not published | $9,239.56 – $11,377.00 | 4 |
| Mastoidectomy CPT 69501 | not published | not published | $6,682.00 – $12,568.00 | 5 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | $6,682.00 – $12,568.00 | 5 |
| Mastoids complete CPT 70130 | $260.10 | $510.00 | $145.47 – $198.30 | 4 |
| Mastoid surgery revision CPT 69603 | not published | not published | $6,682.00 – $12,568.00 | 5 |
| Mastopexy CPT 19316 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Mast radical CPT 19305 | 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.