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 |
|---|---|---|---|---|
| Patient recorded spirometry CPT 94015 | not published | not published | $114.98 – $306.58 | 3 |
| Pca3/klk3 antigen CPT 81313 | not published | not published | $249.95 – $1,181.74 | 4 |
| Pcv21 vaccine im CPT 90684 | not published | not published | $411.56 – $704.96 | 2 |
| Pdgfra gene CPT 81314 | not published | not published | $322.92 – $2,159.22 | 4 |
| Pdt dstr prmlg les phys/qhp CPT 96573 | not published | not published | $279.18 – $1,716.00 | 3 |
| Pedcle fh/ch/ch/m/n/ax/g/h/f CPT 15574 | not published | not published | $2,870.98 – $5,318.00 | 5 |
| Ped home apnea mntr att only CPT 94775 | not published | not published | $179.04 – $355.70 | 3 |
| Ped home apnea mntr dl&alys CPT 94776 | not published | not published | $179.04 – $281.25 | 3 |
| Pedicle enel/ntroral 15576 CPT 15576 | $3,760.74 | $7,374.00 | $2,870.98 – $5,318.00 | 5 |
| Pegademase bovine, 25 iu HCPCS J2504 | not published | not published | $194.37 – $332.43 | 2 |
| Pegaptanib sodium injection HCPCS J2503 | not published | not published | $1,482.94 – $1,951.43 | 2 |
| Pegaspargase injection HCPCS J9266 | $46,524.80 | $91,225.09 | $1,791.47 – $58,201.64 | 4 |
| Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector HCPCS J2506 | not published | not published | $39.96 – $765.26 | 4 |
| Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe HCPCS Q5122 | not published | not published | $130.64 – $467.95 | 4 |
| Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe HCPCS Q5111 | not published | not published | $133.17 – $497.81 | 4 |
| Pegfilgrastim-fpgk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5127 | not published | not published | $155.09 – $540.19 | 4 |
| Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe HCPCS Q5108 | not published | not published | $77.91 – $497.81 | 4 |
| Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5130 | not published | not published | $109.89 – $352.92 | 4 |
| Peginesatide injection HCPCS J0890 | not published | not published | $15.49 – $15.49 | 1 |
| Peg interferon alfa-2a/180 HCPCS S0145 | not published | not published | $1,461.53 – $1,461.53 | 1 |
| Pegloticase 8 mg/ml intravenous solution HCPCS J2507 | not published | not published | $411.38 – $7,665.44 | 4 |
| Pegunigalsidase alfa-iwxj HCPCS J2508 | not published | not published | $218.93 – $487.90 | 4 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $5,003.61 | $9,811.00 | $244.06 – $2,105.09 | 4 |
| Pelvic CT scan (with contrast) CPT 72193 | $4,925.07 | $9,657.00 | $244.06 – $1,700.58 | 4 |
| Pelvic CT scan (without contrast) CPT 72192 | $3,663.84 | $7,184.00 | $145.47 – $1,471.38 | 4 |
| Pelvic exenteration CPT 45126 | not published | not published | $4,233.00 – $12,568.00 | 3 |
| Pelvic MRI (with and without contrast) CPT 72197 | $9,713.97 | $19,047.00 | $485.45 – $6,283.55 | 4 |
| Pelvic MRI (with contrast) CPT 72196 | $5,238.72 | $10,272.00 | $485.45 – $2,780.99 | 4 |
| Pelvic MRI (without contrast) CPT 72195 | $4,383.96 | $8,596.00 | $332.01 – $2,835.59 | 4 |
| Pelvic ring fracture uni/bil HCPCS G0413 | not published | not published | $5,318.00 – $11,377.00 | 4 |
| Pelvic ring fx treat int fix HCPCS G0414 | not published | not published | $9,773.00 – $15,575.00 | 4 |
| Pelvic Ultrasound (complete) CPT 76856 | $1,304.58 | $2,558.00 | $145.47 – $385.19 | 4 |
| Pelvic Ultrasound (limited) CPT 76857 | $895.56 | $1,756.00 | $145.47 – $264.89 | 4 |
| Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 | not published | not published | $60.03 – $127.60 | 4 |
| Pemetrexed disodium 100 mg intravenous powder for solution HCPCS J9305 | $200.38 | $392.90 | $3.96 – $58.15 | 4 |
| Peng benzathine/procaine inj HCPCS J0558 | $447.20 | $876.87 | $4.54 – $37.35 | 4 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $664.28 | $1,302.51 | $5.75 – $58.01 | 4 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | $226.04 | $443.22 | $1.55 – $2.87 | 3 |
| Penicillin g procaine inj HCPCS J2510 | $168.21 | $329.82 | $11.41 – $101.46 | 2 |
| Penile injection CPT 54235 | $465.63 | $913.00 | $347.66 – $1,716.00 | 4 |
| Penile rear tip xtnd 0.5cm HCPCS C2622 | $31,177.60 | $61,132.55 | not published | 0 |
| Penile vascular study CPT 93980 | $166.26 | $326.00 | $145.47 – $934.76 | 3 |
| Penile vascular study CPT 93981 | not published | not published | $145.47 – $872.71 | 3 |
| Penile venous occlusion CPT 37790 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Penis plastic surgery CPT 54360 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Penis study CPT 54240 | not published | not published | $300.45 – $4,042.00 | 5 |
| Pentamidine non-comp unit HCPCS J2545 | $298.87 | $586.01 | $130.85 – $170.93 | 3 |
| Pentastarch 10% solution HCPCS J2513 | not published | not published | $18.18 – $18.18 | 1 |
| Pentazocine injection HCPCS J3070 | not published | not published | $36.35 – $57.02 | 2 |
| Pentobarbital sodium inj HCPCS J2515 | $238.48 | $467.61 | $2.97 – $145.17 | 4 |
| Pentostatin 10 mg intravenous solution HCPCS J9268 | not published | not published | $2,306.44 – $5,747.87 | 4 |
| Perc cryo ablate renal tum CPT 50593 | $15,746.25 | $30,875.00 | $3,423.00 – $15,575.00 | 5 |
| Perc d-e cor revasc chro add HCPCS C9608 | not published | not published | $1,716.00 – $12,568.00 | 3 |
| Perc d-e cor revasc chro sin HCPCS C9607 | $22,111.05 | $43,355.00 | $4,812.00 – $26,028.38 | 5 |
| Perc d-e cor revasc t cabg b HCPCS C9605 | $22,111.05 | $43,355.00 | $1,716.00 – $12,568.00 | 3 |
| Perc d-e cor revasc t cabg s HCPCS C9604 | $22,111.05 | $43,355.00 | $4,812.00 – $20,488.00 | 5 |
| Perc d-e cor stent ather br HCPCS C9603 | $15,482.07 | $30,357.00 | $1,716.00 – $12,568.00 | 3 |
| Perc d-e cor stent ather s HCPCS C9602 | $22,111.05 | $43,355.00 | $4,812.00 – $26,028.38 | 5 |
| Perc drug-el cor stent bran HCPCS C9601 | $22,111.05 | $43,355.00 | $1,716.00 – $12,568.00 | 3 |
| Perc drug-el cor stent sing HCPCS C9600 | $22,528.74 | $44,174.00 | $4,812.00 – $20,488.00 | 5 |
| Perc rf ablate renal tumor CPT 50592 | $9,338.10 | $18,310.00 | $4,812.00 – $15,575.00 | 5 |
| Percut ablate liver rf CPT 47382 | $7,270.56 | $14,256.00 | $6,682.00 – $15,575.00 | 5 |
| Percutaneous islet celltrans HCPCS G0341 | not published | not published | $4,042.00 – $4,042.00 | 1 |
| Perflutren lipid microspheres 1.1 mg/ml intravenous suspension HCPCS Q9957 | not published | not published | $82.07 – $90.04 | 3 |
| Pericardial drain w/cath pq w/ct guid CPT 33019 | $5,467.20 | $10,720.00 | $691.00 – $6,732.00 | 3 |
| Pericardiectomy/sub or com/w bypas 33031 CPT 33031 | not published | not published | $2,995.00 – $12,568.00 | 3 |
| Pericardiocentesis wwo imaging CPT 33016 | $2,887.62 | $5,662.00 | $2,190.38 – $4,042.00 | 5 |
| Pericardiotomy/clot/for bod remove 33020 CPT 33020 | $5,198.43 | $10,193.00 | $2,238.00 – $9,773.00 | 3 |
| Peri-implt capslc brst compl CPT 19371 | not published | not published | $4,233.00 – $11,377.00 | 5 |
| Perineoplasty rpr per nonob CPT 56810 | not published | not published | $4,504.34 – $9,773.00 | 5 |
| Peripheral vascular rehab CPT 93668 | not published | not published | $82.09 – $83.76 | 2 |
| Peri-proc device eval icd CPT 93287 | $348.84 | $684.00 | $78.66 – $97.20 | 2 |
| Peri-proc device eval pm CPT 93286 | $315.18 | $618.00 | $72.38 – $87.27 | 2 |
| Peritoneal cath sub q resv per CPT 49419 | not published | not published | $4,042.00 – $15,575.00 | 5 |
| Peritoneogram rs&i CPT 74190 | $780.81 | $1,531.00 | $325.45 – $775.83 | 4 |
| Perit-vens shunt pat tst CPT 78291 | not published | not published | $556.27 – $768.90 | 4 |
| Permanent tear duct plug HCPCS A4263 | $498.53 | $977.50 | not published | 0 |
| Perphenazine 4mg oral HCPCS Q0175 | not published | not published | $1.21 – $1.40 | 2 |
| Perphenazine injeciton HCPCS J3310 | not published | not published | $9.00 – $9.00 | 1 |
| Perq art m-thrombect &/nfs CPT 61645 | not published | not published | $5,318.00 – $20,652.00 | 3 |
| Perq clsr tcat l atr apndge CPT 33340 | $11,608.62 | $22,762.00 | $6,511.00 – $11,377.00 | 3 |
| Perq dev breast 1st mr guide CPT 19287 | $1,676.37 | $3,287.00 | $985.34 – $4,042.00 | 4 |
| Perq dev breast 1st strtctc CPT 19283 | $1,676.37 | $3,287.00 | $985.34 – $4,042.00 | 4 |
| Perq nl/pl lithotrp cplx>2cm CPT 50081 | not published | not published | $5,318.00 – $13,441.06 | 5 |
| Perq nl/pl lithotrp smpl<2cm CPT 50080 | not published | not published | $5,318.00 – $13,441.06 | 5 |
| Perq p-art revsc 1 abnor bi CPT 33903 | not published | not published | $2,238.00 – $20,488.00 | 5 |
| Perq p-art revsc 1 abnor uni CPT 33902 | not published | not published | $2,238.00 – $25,507.82 | 5 |
| Perq p-art revsc 1 nm nt bi CPT 33901 | not published | not published | $2,238.00 – $20,488.00 | 5 |
| Perq p-art revsc 1 nm nt uni CPT 33900 | not published | not published | $2,238.00 – $20,488.00 | 5 |
| Perq p-art revsc each addl CPT 33904 | not published | not published | $691.00 – $12,908.00 | 3 |
| Perq plmt bile duct stent CPT 47538 | $7,111.44 | $13,944.00 | $3,423.00 – $15,575.00 | 5 |
| Perq plmt bile duct stent CPT 47539 | not published | not published | $3,423.00 – $15,575.00 | 5 |
| Perq plmt bile duct stent CPT 47540 | not published | not published | $3,423.00 – $15,575.00 | 5 |
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | $1,288.26 | $2,526.00 | $347.66 – $4,042.00 | 5 |
| Perq skel fix rad/uln dislc CPT 25671 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Perq skel fix ulnar styld fx CPT 25651 | not published | not published | $4,042.00 – $6,732.00 | 5 |
| Perqt bx lung/mediastinum 32405 CPT 32405 | not published | not published | $4,042.00 – $9,858.00 | 2 |
| Perq transcath closure each CPT 93592 | $19,422.33 | $38,083.00 | $1,716.00 – $12,908.00 | 3 |
| Perq transcath closure pda CPT 93582 | not published | not published | $9,773.00 – $25,507.82 | 4 |
| Perq transcath cls aortic CPT 93591 | $23,873.61 | $46,811.00 | $7,768.82 – $25,507.82 | 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.