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 |
|---|---|---|---|---|
| Prepare donor heart CPT 33944 | not published | not published | $5,318.00 – $6,732.00 | 2 |
| Prepare donor heart/lung CPT 33933 | not published | not published | $5,318.00 – $6,732.00 | 2 |
| Prepare donor intestine CPT 44715 | not published | not published | $5,318.00 – $6,732.00 | 2 |
| Prepare donor lung double CPT 32856 | not published | not published | $5,318.00 – $6,732.00 | 2 |
| Prepare donor lung single CPT 32855 | not published | not published | $5,318.00 – $6,732.00 | 2 |
| Prepare embryo for transfer CPT 89255 | not published | not published | $72.51 – $709.04 | 4 |
| Prepare fecal microbiota CPT 44705 | not published | not published | $2,238.00 – $12,908.00 | 3 |
| Prepare heart-aorta conduit CPT 33404 | not published | not published | $3,423.00 – $9,773.00 | 3 |
| Prepare penis study CPT 54230 | not published | not published | $614.52 – $1,716.00 | 2 |
| Prepare sperm duct x-ray CPT 55300 | not published | not published | $1,396.79 – $4,042.00 | 3 |
| Prep cadaver renal allograft CPT 50323 | not published | not published | $5,318.00 – $6,732.00 | 2 |
| Prep corneal endo allograft CPT 65757 | not published | not published | $1,716.00 – $4,042.00 | 3 |
| Prep donor intestine/artery CPT 44721 | not published | not published | $4,042.00 – $6,732.00 | 2 |
| Prep donor intestine/venous CPT 44720 | not published | not published | $4,042.00 – $6,732.00 | 2 |
| Prep donor liver 3-segment CPT 47144 | not published | not published | $5,318.00 – $6,732.00 | 2 |
| Prep donor liver/arterial CPT 47147 | not published | not published | $4,042.00 – $6,732.00 | 2 |
| Prep donor liver lobe split CPT 47145 | not published | not published | $5,318.00 – $6,732.00 | 2 |
| Prep donor liver/venous CPT 47146 | not published | not published | $4,042.00 – $6,732.00 | 2 |
| Prep donor liver whole CPT 47143 | not published | not published | $5,318.00 – $6,732.00 | 2 |
| Prep donor pancreas CPT 48551 | not published | not published | $5,318.00 – $5,318.00 | 1 |
| Prep donor pancreas/venous CPT 48552 | not published | not published | $4,042.00 – $4,042.00 | 1 |
| Prep donor renal graft CPT 50325 | not published | not published | $5,318.00 – $6,732.00 | 2 |
| Prepj skn cll ssp agrft 1st CPT 15013 | not published | not published | $691.00 – $15,575.00 | 5 |
| Prepj tum cav iort prtl mast CPT 19294 | not published | not published | $1,716.00 – $12,908.00 | 4 |
| Pre-plan 3d model w/ccta HCPCS C9793 | not published | not published | $1,194.91 – $1,219.29 | 2 |
| Prep renal graft/arterial CPT 50328 | not published | not published | $4,042.00 – $6,732.00 | 2 |
| Prep renal graft/ureteral CPT 50329 | not published | not published | $4,042.00 – $6,732.00 | 2 |
| Prep renal graft/venous CPT 50327 | not published | not published | $4,042.00 – $6,732.00 | 2 |
| Prep skin cell susp, automtd HCPCS C8002 | not published | not published | $691.00 – $10,076.45 | 3 |
| Prep skin to 100cm2 other CPT 15004 | $1,266.33 | $2,483.00 | $565.65 – $4,042.00 | 5 |
| Prep skin to 100cm2 trk/ext CPT 15002 | $3,760.74 | $7,374.00 | $1,028.39 – $4,737.00 | 5 |
| Prep skn trk/ext adl 100cm2 CPT 15003 | $2,867.22 | $5,622.00 | $1,716.00 – $12,908.00 | 4 |
| Pressure max expiratory/inspiratory CPT 94799 | $277.44 | $544.00 | $179.04 – $182.70 | 2 |
| Pressure treatment esophagus CPT 43460 | $3,359.88 | $6,588.00 | $2,238.00 – $6,732.00 | 3 |
| Pressure velocity wire add ves CPT 93572 | $1,797.24 | $3,524.00 | $787.93 – $1,716.00 | 2 |
| Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref CPT 86977 | not published | not published | $126.39 – $287.00 | 4 |
| Pretreat rbc absorption reference CPT 86978 | $219.30 | $430.00 | $66.86 – $157.94 | 4 |
| Pretreat rbc density gradient separation reference CPT 86972 | not published | not published | $157.94 – $287.00 | 4 |
| Pretreat rbc w chem/drugs reference CPT 86970 | not published | not published | $66.86 – $126.39 | 4 |
| Pretreat rbc w enzyme reference CPT 86971 | $70.89 | $139.00 | $93.83 – $566.82 | 4 |
| Pr evaluation psychiatric diagnostic w/medical services CPT 90792 | $208.08 | $408.00 | $246.98 – $252.02 | 2 |
| Pr exam init preventive phys new visit during 1st 12 mo of mcare enrollment HCPCS G0402 | not published | not published | $185.25 – $189.04 | 2 |
| Pr excision benign lesion scalp/neck/hands/feet/genitalia <= 0.5 cm CPT 11420 | $3,247.68 | $6,368.00 | $2,238.00 – $4,042.00 | 5 |
| Pr excision benign lesion trunk/arms/legs 3.1 - 4.0 cm CPT 11404 | $3,247.68 | $6,368.00 | $2,238.00 – $4,737.00 | 5 |
| Pr excision nail/nail matrix partial/complete permanent removal CPT 11750 | $684.42 | $1,342.00 | $565.65 – $4,042.00 | 5 |
| Pr gastrorrhaphy suture perforated duodenal or gastric ulcer/wound/ injury CPT 43840 | not published | not published | $2,238.00 – $11,377.00 | 5 |
| Prgrmg dev eval impltbl sys CPT 93260 | not published | not published | $51.93 – $237.83 | 3 |
| Prgrmg dev eval pm/ldls pm CPT 93279 | $171.87 | $337.00 | $51.93 – $162.55 | 3 |
| Prgrmg dev eval scrms ip CPT 93285 | not published | not published | $51.93 – $131.53 | 3 |
| Prgrmg eval implantable dfb CPT 93282 | $184.11 | $361.00 | $51.93 – $171.65 | 3 |
| Prgrmg eval implantable dfb CPT 93283 | $430.95 | $845.00 | $51.93 – $195.22 | 3 |
| Prgrmg eval implantable dfb CPT 93284 | $575.28 | $1,128.00 | $51.93 – $221.69 | 3 |
| Prgr stim/pace a/iv drug CPT 93623 | $5,704.35 | $11,185.00 | $1,716.00 – $5,318.00 | 2 |
| Prim art mech thrmbc non-intracranial CPT 37184 | $14,433.51 | $28,301.00 | $3,423.00 – $26,028.38 | 5 |
| Prim art mech thrmbc non-intracranial add-on CPT 37185 | $4,367.13 | $8,563.00 | $1,716.00 – $15,202.00 | 4 |
| Prin care mgmt staff 1st 30 CPT 99426 | not published | not published | $141.36 – $144.24 | 2 |
| Pr incision & drainage abscess complicated/multiple CPT 10061 | $801.72 | $1,572.00 | $565.65 – $4,042.00 | 5 |
| Pr incision & drainage abscess simple/single CPT 10060 | $544.68 | $1,068.00 | $279.18 – $4,042.00 | 5 |
| Pr incision & drainage abscess vulva/perineal CPT 56405 | $544.68 | $1,068.00 | $424.02 – $4,042.00 | 5 |
| Pr incision & removal foreign body subcutaneous tissues simple CPT 10120 | $1,014.39 | $1,989.00 | $565.65 – $4,042.00 | 5 |
| Pr management transitional care high w/in 7 days of discharge CPT 99496 | not published | not published | $185.25 – $189.04 | 2 |
| Pr management transitional care moderate w/in 14 days of discharge CPT 99495 | not published | not published | $185.25 – $189.04 | 2 |
| Pr moderate sedation same physician >= 5 years initial 15 minutes CPT 99152 | $267.75 | $525.00 | not published | 0 |
| Pr neuroplasty and/or transposition ulnar nerve at elbow CPT 64718 | not published | not published | $2,717.15 – $6,732.00 | 5 |
| Probe cryo 1150mm endo flex ster disp HCPCS C2618 | $15,504.00 | $30,400.00 | not published | 0 |
| Probe nasolacrimal duct CPT 68810 | not published | not published | $441.66 – $4,042.00 | 5 |
| Probe nasolacrimal duct CPT 68811 | not published | not published | $2,995.00 – $6,732.00 | 5 |
| Probe nasolacrimal duct CPT 68815 | not published | not published | $2,995.00 – $6,732.00 | 5 |
| Probe nl duct w/balloon CPT 68816 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Procainamide 100 mg/ml injection (wrapper) HCPCS J2690 | $1,441.17 | $2,825.82 | $43.96 – $611.33 | 4 |
| Procalcitonin CPT 84145 | $144.84 | $284.00 | $26.68 – $143.88 | 4 |
| Procarbazine 50 mg caps 100 each bottle HCPCS S0182 | not published | not published | $119.60 – $119.60 | 1 |
| Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution HCPCS J0780 | $84.15 | $165.00 | $5.83 – $10.94 | 3 |
| Prochlorperazine maleate 5 mg tablet HCPCS Q0164 | not published | not published | $0.65 – $1.70 | 2 |
| Proctectomy combined abd pull-thru px 45112 CPT 45112 | not published | not published | $2,995.00 – $12,568.00 | 3 |
| Proctectomy complete abd w/clst 45110 CPT 45110 | not published | not published | $2,995.00 – $12,568.00 | 3 |
| Proctosigmoidoscopy ablate CPT 45320 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Proctosigmoidoscopy control bleed 45317 CPT 45317 | not published | not published | $1,665.08 – $4,737.00 | 5 |
| Proctosigmoidoscopy dilate 45303 CPT 45303 | not published | not published | $1,665.08 – $4,737.00 | 5 |
| Proctosigmoidoscopy dx 45300 CPT 45300 | $1,612.62 | $3,162.00 | $1,294.00 – $4,042.00 | 5 |
| Proctosigmoidoscopy removal CPT 45308 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Proctosigmoidoscopy removal CPT 45309 | not published | not published | $1,665.08 – $4,737.00 | 5 |
| Proctosigmoidoscopy tumor removal 45315 CPT 45315 | not published | not published | $1,665.08 – $4,737.00 | 5 |
| Proctosigmoidoscopy volvul CPT 45321 | not published | not published | $2,238.00 – $6,732.00 | 5 |
| Proctosigmoidoscopy w/bx 45305 CPT 45305 | not published | not published | $1,665.08 – $4,737.00 | 5 |
| Proctosigmoidoscopy w/fb remove 45307 CPT 45307 | $4,986.27 | $9,777.00 | $2,238.00 – $6,732.00 | 5 |
| Proctosigmoidoscopy w/stent CPT 45327 | not published | not published | $4,042.00 – $11,377.00 | 5 |
| Progenamatrix, per sq cm HCPCS Q4222 | not published | not published | $173.16 – $292.25 | 4 |
| Progesterone CPT 84144 | $254.49 | $499.00 | $20.44 – $183.11 | 4 |
| Prolactin CPT 84146 | $189.72 | $372.00 | $18.99 – $170.05 | 4 |
| Prolng ip/obs e/m ea 15 min CPT 99418 | not published | not published | $691.00 – $691.00 | 1 |
| Prolonged IV inf, req pump HCPCS C8957 | $576.30 | $1,130.00 | $295.97 – $302.01 | 2 |
| Prolong home eval add 15m HCPCS G0318 | not published | not published | $691.00 – $691.00 | 1 |
| Promethazine 25 mg tablet HCPCS Q0169 | not published | not published | $0.56 – $0.60 | 2 |
| Promethazine hcl injection HCPCS J2550 | $84.15 | $165.00 | $1.30 – $7.12 | 3 |
| Proph rta dtchmnt crtx dthrm CPT 67141 | not published | not published | $441.66 – $4,042.00 | 5 |
| Proph rta dtchmnt pc CPT 67145 | not published | not published | $765.30 – $4,042.00 | 5 |
| Proph tx w/wo mthylmthcrylt CPT 24498 | not published | not published | $3,423.00 – $18,229.15 | 5 |
| Prophylactic tx radius CPT 25490 | not published | not published | $3,423.00 – $11,377.00 | 5 |
| Prophylactic tx radius&ulna CPT 25492 | not published | not published | $3,423.00 – $11,377.00 | 5 |
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.