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 |
|---|---|---|---|---|
| Assay of rbc pg6d enzyme CPT 84085 | not published | not published | $9.25 – $59.15 | 4 |
| Assay of salicylate CPT 80179 | $600.78 | $1,178.00 | $18.27 – $55.48 | 4 |
| Assay of semen fructose CPT 82757 | not published | not published | $16.99 – $152.74 | 4 |
| Assay of sialic acid CPT 84275 | not published | not published | $13.17 – $117.82 | 4 |
| Assay of silica CPT 84285 | not published | not published | $24.71 – $206.63 | 4 |
| Assay of somatostatin CPT 84307 | not published | not published | $17.91 – $155.28 | 4 |
| Assay of thiocyanate CPT 84430 | not published | not published | $11.40 – $102.10 | 4 |
| Assay of troponin qual CPT 84512 | not published | not published | $9.89 – $129.99 | 4 |
| Assay of tyrosine CPT 84510 | not published | not published | $10.42 – $91.29 | 4 |
| Assay of urine sulfate CPT 84392 | $17.85 | $35.00 | $5.38 – $41.83 | 4 |
| Assay of urine urobilinogen CPT 84580 | not published | not published | $9.36 – $62.28 | 4 |
| Assay of urine urobilinogen CPT 84583 | not published | not published | $5.93 – $44.08 | 4 |
| Assay phosphatidylglycerol CPT 84081 | not published | not published | $16.19 – $140.33 | 4 |
| Assay phosphohexose enzymes CPT 84087 | not published | not published | $10.52 – $90.58 | 4 |
| Assay rbc glutathione CPT 82979 | not published | not published | $9.25 – $60.39 | 4 |
| Assay toxin or antitoxin CPT 87230 | $121.89 | $239.00 | $19.35 – $173.30 | 4 |
| Assess aphasia/interp/rpt/per hr 96105 CPT 96105 | not published | not published | $99.19 – $484.75 | 3 |
| Assess care plan pt w/cog impair 99483 CPT 99483 | not published | not published | $141.36 – $144.24 | 2 |
| Assess cyst contrast inject CPT 49424 | $262.65 | $515.00 | $290.27 – $4,042.00 | 3 |
| Assessment leukocyte fecal qualitative/semiquantitative CPT 89055 | $168.30 | $330.00 | $4.18 – $37.46 | 4 |
| Asses tinnit/pitch/loud/match/mask 92625 CPT 92625 | not published | not published | $179.04 – $396.65 | 3 |
| Assist-bilat spinal disk surgery add-on 63035 CPT 63035 | not published | not published | $1,716.00 – $24,668.00 | 4 |
| Assistive tech assessment, ot CPT 97755 | not published | not published | $38.75 – $39.54 | 2 |
| Assist oocyte fertilization CPT 89280 | not published | not published | $1,121.07 – $4,550.41 | 4 |
| Assist oocyte fertilization CPT 89281 | not published | not published | $237.06 – $5,022.40 | 4 |
| Ast/sgot CPT 84450 | $164.22 | $322.00 | $5.08 – $45.38 | 4 |
| Atezolizumab 60 mg/ml intravenous solution (wrapper) HCPCS J9022 | not published | not published | $92.12 – $192.19 | 4 |
| Athrectomy fem/pop/unilateral 37225 CPT 37225 | $20,079.21 | $39,371.00 | $4,233.00 – $62,607.00 | 5 |
| Athrectomy tib/pero/unilat/ini ves 37229 CPT 37229 | $20,278.62 | $39,762.00 | $4,233.00 – $89,248.00 | 5 |
| Atomic absorption CPT 82190 | not published | not published | $15.58 – $126.56 | 4 |
| Atropine 0.1 mg/ml injection syringe HCPCS J0461 | $84.15 | $165.00 | $0.22 – $0.37 | 3 |
| Attach bladder/urethra comp 51841 CPT 51841 | not published | not published | $2,238.00 – $25,815.00 | 4 |
| Attach bladder/urethra simple 51840 CPT 51840 | not published | not published | $2,238.00 – $9,773.00 | 5 |
| Attach ocular implant CPT 65140 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Aud brainstem implt programg CPT 92640 | not published | not published | $179.04 – $182.70 | 2 |
| Audiometry air + bone CPT 92553 | not published | not published | $179.04 – $182.70 | 2 |
| Auditory function 60 min CPT 92620 | not published | not published | $179.04 – $403.68 | 3 |
| Augmentation cheek bone CPT 21270 | not published | not published | $4,812.00 – $11,377.00 | 5 |
| Augmentation lower jaw bone CPT 21125 | not published | not published | $4,042.00 – $8,405.34 | 5 |
| Augmentation lower jaw bone CPT 21127 | not published | not published | $8,237.23 – $11,377.00 | 5 |
| Augmentation of facial bones CPT 21208 | not published | not published | $6,682.00 – $11,377.00 | 5 |
| Augment injectable kit 3.0cc HCPCS C1734 | $9,769.97 | $19,156.80 | not published | 0 |
| Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body CPT 22515 | $11,132.28 | $21,828.00 | $1,716.00 – $12,908.00 | 4 |
| Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic CPT 22513 | $16,614.78 | $32,578.00 | $4,042.00 – $15,575.00 | 5 |
| Autgrft implnt knee w/scope CPT 29866 | not published | not published | $8,992.00 – $15,575.00 | 5 |
| Autochondrocyte implant knee CPT 27412 | not published | not published | $8,992.00 – $15,575.00 | 5 |
| Autoimmune rheumatoid arthr anl 12 mrk ia CPT 81490 | not published | not published | $823.84 – $4,460.48 | 4 |
| Autologous blood op salvage CPT 86891 | not published | not published | $394.88 – $1,256.40 | 4 |
| Autologous blood process CPT 86890 | not published | not published | $237.06 – $394.88 | 4 |
| Autolog prp diab wound ulcer HCPCS G0465 | not published | not published | $2,870.98 – $2,929.57 | 2 |
| Autolog prp not diab ulcer HCPCS G0460 | not published | not published | $2,870.98 – $2,929.57 | 2 |
| Automated diff wbc count CPT 85004 | not published | not published | $6.34 – $56.72 | 4 |
| Autonomic nrv adrenrg inervj CPT 95922 | not published | not published | $105.88 – $188.91 | 3 |
| Autonomic nrv parasym inervj CPT 95921 | not published | not published | $103.82 – $182.70 | 3 |
| Autonomic nrv syst funj test CPT 95923 | not published | not published | $103.82 – $188.91 | 3 |
| Avelumab 20 mg/ml intravenous solution HCPCS J9023 | not published | not published | $103.43 – $208.85 | 4 |
| Av fistula revision CPT 36833 | not published | not published | $4,233.00 – $15,575.00 | 5 |
| Av fuse uppr arm basilic CPT 36819 | not published | not published | $3,423.00 – $15,575.00 | 5 |
| Av fuse uppr arm cephalic CPT 36818 | not published | not published | $5,318.00 – $15,575.00 | 5 |
| Av fusion direct any site CPT 36821 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Av fusion/forearm vein 36820 CPT 36820 | not published | not published | $3,423.00 – $15,575.00 | 5 |
| Avul nail plate addl CPT 11732 | $621.69 | $1,219.00 | $1,716.00 – $12,908.00 | 4 |
| Avulsion nail plate partial/complete simple single nail plate CPT 11730 | $684.42 | $1,342.00 | $279.18 – $4,042.00 | 5 |
| Axatilimab-csfr 22 mg/0.44ml soln 0.44 ml vial HCPCS J9038 | not published | not published | $54.54 – $135.45 | 3 |
| Axicabtagene ciloleucel car+ HCPCS Q2041 | not published | not published | $521,212.14 – $1,081,107.57 | 3 |
| Axillary lymphadenect/superficial 38740 CPT 38740 | not published | not published | $2,995.00 – $15,575.00 | 5 |
| Azacitidine injection HCPCS J9025 | $1,813.82 | $3,556.51 | $0.63 – $5.38 | 3 |
| Azathioprine 50 mg tablet HCPCS J7500 | $5.61 | $11.00 | $2.03 – $144.11 | 3 |
| Azathioprine parenteral HCPCS J7501 | not published | not published | $112.40 – $483.69 | 4 |
| Azithromycin 500 mg intravenous solution HCPCS J0456 | $84.15 | $165.00 | $4.44 – $31.44 | 3 |
| Aztreonam 1 gram solution for injection HCPCS J0457 | $257.36 | $504.63 | $4.27 – $5.33 | 3 |
| Baclofen 2,000 mcg/ml intrathecal solution (wrapper) HCPCS J0475 | $240.53 | $471.62 | $174.49 – $375.82 | 4 |
| Baclofen 50 mcg/ml intrathecal solution (wrapper) HCPCS J0476 | not published | not published | $103.40 – $115.71 | 3 |
| Baclofen eval charges CPT 97750 | $67.83 | $133.00 | $42.44 – $43.31 | 2 |
| Bacterial meningitis antigen CPT 86403 | $47.46 | $93.05 | $11.31 – $86.86 | 4 |
| Bacterial vaginosis pcr CPT 87801 | $151.98 | $298.00 | $68.80 – $307.84 | 4 |
| Bactericidal level serum CPT 87197 | not published | not published | $14.72 – $102.69 | 4 |
| #bac vag cand-c. albicans naa CPT 87481 | $83.39 | $163.50 | $34.39 – $298.03 | 4 |
| Balloon dilate urtrl strix CPT 50706 | $3,715.35 | $7,285.00 | $1,716.00 – $12,908.00 | 3 |
| Bartholin gland cyst/marsupializat 56440 CPT 56440 | $6,124.08 | $12,008.00 | $2,995.00 – $6,732.00 | 5 |
| Bartonella dna pcr-sendout CPT 87471 | not published | not published | $34.39 – $298.03 | 4 |
| Basic vestibular evaluation CPT 92540 | not published | not published | $300.45 – $306.58 | 2 |
| Basiliximab HCPCS J0480 | not published | not published | $2,011.35 – $10,078.47 | 4 |
| Bausch health Ultrasound surg HCPCS V2788 | $3,410.98 | $6,688.20 | not published | 0 |
| B cells total count CPT 86355 | $47.89 | $93.91 | $36.98 – $323.86 | 4 |
| Bcg live 50 mg intravesical suspension HCPCS J9030 | not published | not published | $3.32 – $6.75 | 4 |
| Bckdhb gene CPT 81205 | not published | not published | $93.09 – $829.58 | 4 |
| Becaplermin 0.01% gel 15 gm HCPCS S0157 | not published | not published | $51.92 – $51.92 | 1 |
| Behavior counsel obesity 15min medicare g0447 HCPCS G0447 | not published | not published | $141.36 – $144.24 | 2 |
| Belatacept 250 mg intravenous solution HCPCS J0485 | not published | not published | $3.82 – $8.36 | 4 |
| Belimumab 120 mg intravenous solution HCPCS J0490 | not published | not published | $52.86 – $118.19 | 4 |
| Bendamustine 100 mg intravenous powder for solution HCPCS J9033 | not published | not published | $2.12 – $26.89 | 4 |
| Bendamustine 25 mg/ml intravenous solution (belrapzo) HCPCS J9036 | not published | not published | $13.66 – $37.20 | 4 |
| Bendamustine 25 mg/ml intravenous solution (bendeka) HCPCS J9034 | $6,029.71 | $11,822.97 | $12.64 – $33.29 | 4 |
| Bendamustine 25 mg/ml intravenous solution (vivimusta) HCPCS J9056 | not published | not published | $31.10 – $58.57 | 4 |
| Benign lesion paring 2-4 CPT 11056 | $391.68 | $768.00 | $279.18 – $1,716.00 | 4 |
| Benign lesion paring 4+ CPT 11057 | $391.68 | $768.00 | $279.18 – $1,716.00 | 4 |
| #_benzodiazconfur CPT 80346 | $11.22 | $22.00 | $0.07 – $149.08 | 2 |
| Benztropine 1 mg/ml injection solution HCPCS J0515 | $125.82 | $246.71 | $8.07 – $36.06 | 3 |
| Beta 2 glycoprotein 1 antibody iga CPT 86146 | $44.80 | $87.85 | $24.94 – $223.17 | 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.