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 |
|---|---|---|---|---|
| Blepharoplasty upper 15822 CPT 15822 | not published | not published | $2,870.98 – $4,737.00 | 5 |
| Blepharoplasty upper eyelid 15823 CPT 15823 | not published | not published | $2,870.98 – $4,812.00 | 5 |
| Blepharp lwr eyelid fat pad CPT 15821 | not published | not published | $2,870.98 – $4,737.00 | 5 |
| Blinatumomab 35 mcg intravenous solution HCPCS J9039 | not published | not published | $136.32 – $327.40 | 4 |
| Blind cor sinus reducer impl HCPCS C9783 | not published | not published | $16,063.33 – $20,488.00 | 3 |
| Blinded conv. tx mdd clin tr HCPCS G2000 | not published | not published | $519.24 – $529.83 | 2 |
| Blind interatrial shunt ide HCPCS C9758 | not published | not published | $12,568.00 – $24,321.49 | 4 |
| Blind myocar trpl bon marrow HCPCS C9782 | not published | not published | $20,488.00 – $24,321.49 | 3 |
| Blind/nonblind trans atrial HCPCS C9792 | not published | not published | $13,279.84 – $20,488.00 | 3 |
| Blink reflex test CPT 95933 | not published | not published | $82.09 – $237.00 | 3 |
| Blm gene CPT 81209 | not published | not published | $38.52 – $338.57 | 4 |
| Bln 1.2 mono emrg 15x1.2 HCPCS C1725 | $14,621.70 | $28,670.00 | not published | 0 |
| Bln 30frx10mmx12cm renal nephromax HCPCS C1726 | $18,294.72 | $35,872.00 | not published | 0 |
| Bln dil 900ml preperitnl HCPCS C1727 | $1,585.75 | $3,109.31 | not published | 0 |
| Bln inpact admiral 4x150x130cm HCPCS C2623 | $7,564.32 | $14,832.00 | not published | 0 |
| Bln press regulation 71-80cm HCPCS C1815 | $24,106.68 | $47,268.00 | not published | 0 |
| Bln stent lg 19mm diam 10-12mm palmaz gen trnshpat unmtd HCPCS C1877 | $9,409.09 | $18,449.20 | not published | 0 |
| Block brachial plexus w/cath plmt w/img CPT 64416 | $1,845.69 | $3,619.00 | $1,230.71 – $4,042.00 | 5 |
| Block femoral nerve cont infusion cath w/img CPT 64448 | $1,845.69 | $3,619.00 | $1,230.71 – $4,042.00 | 5 |
| Block paracervical nrv CPT 64435 | not published | not published | $982.21 – $4,042.00 | 5 |
| Block plantar digital nerve CPT 64455 | $861.90 | $1,690.00 | $427.11 – $4,042.00 | 5 |
| Block tap inj(s) w/wo img bi CPT 64488 | $1,819.17 | $3,567.00 | $1,716.00 – $15,202.00 | 4 |
| Block tap inj(s) w/wo img uni CPT 64486 | $1,819.17 | $3,567.00 | $1,716.00 – $15,202.00 | 4 |
| Blood Clotting (PT/INR) Test CPT 85610 | $170.85 | $335.00 | $4.20 – $34.57 | 4 |
| Blood Clotting (PTT) Test CPT 85730 | $262.65 | $515.00 | $5.89 – $52.71 | 4 |
| Blood Count (CBC) Test CPT 85025 | $212.16 | $416.00 | $7.61 – $68.25 | 4 |
| Blood Count (CBC) Test (without differential) CPT 85027 | $122.91 | $241.00 | $6.34 – $56.78 | 4 |
| Blood count spun microhematocrit CPT 85013 | not published | not published | $6.86 – $20.74 | 4 |
| Blood Culture Test CPT 87040 | $279.48 | $548.00 | $10.11 – $90.58 | 4 |
| Blood draw capillary 36416 CPT 36416 | $18.87 | $37.00 | $5.78 – $4,042.00 | 2 |
| Blood gases o2 saturation direct measurement CPT 82805 | $642.60 | $1,260.00 | $77.19 – $246.75 | 4 |
| Blood gases ph venous CPT 82800 | not published | not published | $10.78 – $74.27 | 4 |
| Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic CPT 82274 | $82.11 | $161.00 | $15.60 – $31.84 | 4 |
| Blood occult feces 1-3 determinations other than neoplasm screening qualitative CPT 82272 | $95.88 | $188.00 | $4.15 – $27.89 | 4 |
| Blood occult feces colorectal neoplasm screening qualitative CPT 82270 | $92.31 | $181.00 | $4.29 – $22.04 | 4 |
| Blood occult peroxidase activity qualitative gastric CPT 82271 | $70.38 | $138.00 | $5.21 – $27.89 | 4 |
| Blood smear interpretation CPT 85060 | $167.28 | $328.00 | $50.52 – $138.03 | 3 |
| Blood smear microscopic w manual differential wbc count CPT 85007 | not published | not published | $3.72 – $30.19 | 4 |
| Blood split unit HCPCS P9011 | $115.67 | $226.80 | not published | 0 |
| Blood typing abo CPT 86900 | $125.46 | $246.00 | $5.98 – $185.13 | 4 |
| Blood typing ag donor ea ag CPT 86902 | $324.87 | $637.00 | $12.70 – $498.77 | 4 |
| Blood typing patient serum CPT 86904 | not published | not published | $32.68 – $83.43 | 4 |
| Blood typing rbc ag non abo/rh ea CPT 86905 | $324.87 | $637.00 | $7.66 – $498.77 | 4 |
| Blood typing rh (d) CPT 86901 | $107.10 | $210.00 | $5.98 – $55.31 | 4 |
| Blood typing rh phenotype complete reference CPT 86906 | $60.18 | $118.00 | $15.50 – $68.01 | 4 |
| Blood volume CPT 78122 | not published | not published | $634.95 – $1,157.51 | 4 |
| Blue light cysto imag agent HCPCS C9738 | not published | not published | $1,716.00 – $12,908.00 | 3 |
| Bone biopsy open superficial CPT 20240 | $5,595.21 | $10,971.00 | $2,995.00 – $6,732.00 | 5 |
| Bone Density Scan (DEXA) CPT 77080 | $617.61 | $1,211.00 | $145.47 – $716.73 | 4 |
| Bone filler cerament 10cc HCPCS C1602 | $23,063.75 | $45,223.04 | not published | 0 |
| Bone imaging multiple areas CPT 78305 | $1,677.39 | $3,289.00 | $556.27 – $870.65 | 4 |
| Bone/joint imaging ltd area CPT 78300 | $1,246.95 | $2,445.00 | $556.27 – $611.55 | 4 |
| Bone marrow;aspiration only 38220 CPT 38220 | $2,274.09 | $4,459.00 | $691.00 – $4,042.00 | 5 |
| Bone marrow biopsyneedle/trocar 38221 CPT 38221 | $2,502.06 | $4,906.00 | $691.00 – $4,042.00 | 5 |
| Bone marrow harvest allogen CPT 38230 | not published | not published | $2,167.10 – $4,737.00 | 5 |
| Bone marrow harvest autolog CPT 38232 | not published | not published | $4,042.00 – $11,377.00 | 5 |
| Bone marrow imaging body CPT 78104 | not published | not published | $556.27 – $1,023.51 | 4 |
| Bone marrow imaging ltd CPT 78102 | not published | not published | $512.52 – $589.01 | 4 |
| Bone marrow imaging mult CPT 78103 | not published | not published | $556.27 – $795.78 | 4 |
| Bone marrow interpretation CPT 85097 | $1,255.11 | $2,461.00 | $265.53 – $1,256.40 | 4 |
| Bone/skin graft great toe CPT 20973 | not published | not published | $6,682.00 – $15,575.00 | 5 |
| Bone/skin graft metatarsal CPT 20972 | not published | not published | $4,233.00 – $15,575.00 | 5 |
| Bone survey-lead poisoning CPT 77074 | $2,033.88 | $3,988.00 | $145.47 – $251.30 | 4 |
| Bone tendon board add on HCPCS C9356 | not published | not published | $115.34 – $115.34 | 1 |
| Boot j walker l HCPCS L4386 | $108.38 | $212.50 | not published | 0 |
| Boot mlti podous univ xlg HCPCS L4396 | $246.13 | $482.60 | not published | 0 |
| Boot walker genesis full shell 3-strap s HCPCS L4360 | $853.73 | $1,673.98 | not published | 0 |
| Boot walker genesis mid-calf full shell s HCPCS L4361 | $329.07 | $645.23 | not published | 0 |
| Borrelia antibody CPT 86619 | not published | not published | $13.11 – $115.75 | 4 |
| Borrelia burgdorferi (lyme disease) antibody nonspecific CPT 86618 | $64.90 | $127.25 | $16.69 – $141.40 | 4 |
| Borrelia miyamotoi amp prb CPT 87478 | not published | not published | $34.39 – $186.18 | 4 |
| Bortezomib 3.5 mg (2.5 mg/ml) solution for subcutaneous injection HCPCS J9041 | $222.50 | $436.28 | $5.00 – $40.80 | 3 |
| (both sides) smear without diff wbc count CPT 85008 | not published | not published | $3.36 – $30.19 | 4 |
| Bowel imaging CPT 78290 | $1,764.60 | $3,460.00 | $556.27 – $763.76 | 4 |
| Brace afo lg left 6607 HCPCS L1930 | $775.75 | $1,521.07 | not published | 0 |
| Brace afopos solid ankle cust HCPCS L1960 | $1,630.59 | $3,197.24 | not published | 0 |
| Brace ank air stirrup univ HCPCS L4350 | $136.58 | $267.80 | not published | 0 |
| Brace ankle stablizing lg HCPCS L1902 | $88.64 | $173.80 | not published | 0 |
| Brace back epic lso 637 HCPCS L0650 | $3,055.23 | $5,990.65 | not published | 0 |
| Brace back pinnacle lo 627 lumbar HCPCS L0627 | $1,262.29 | $2,475.07 | not published | 0 |
| Brace back pinnacle tlso 464 HCPCS L0464 | $4,464.56 | $8,754.04 | not published | 0 |
| Brace back t-lso custom HCPCS L0486 | $5,407.85 | $10,603.63 | not published | 0 |
| Brace cust back lso HCPCS L0631 | $758.63 | $1,487.50 | not published | 0 |
| Brace fx hum ovr shldr sm HCPCS L3980 | $1,155.22 | $2,265.13 | not published | 0 |
| Brace knee extender plus 22-30in HCPCS L1832 | $485.78 | $952.51 | not published | 0 |
| Brace knee playmaker ii x-rom hook and loop xl HCPCS L1833 | $306.66 | $601.29 | not published | 0 |
| Brace knee support neoprene padded open patella med HCPCS L1810 | $425.52 | $834.36 | not published | 0 |
| Brace ortho exos 28-50in sm HCPCS L0637 | $801.98 | $1,572.50 | not published | 0 |
| Brace ortho tlso 2xl 19in strnl y bar wst belt pd shldr HCPCS L0456 | $3,011.11 | $5,904.14 | not published | 0 |
| Brace oths wrist hnd fngr without HCPCS L3807 | $453.57 | $889.35 | not published | 0 |
| Brace wrist classic lft sm HCPCS L3908 | $55.95 | $109.70 | not published | 0 |
| Brachioplasty 15836 CPT 15836 | not published | not published | $2,238.00 – $4,737.00 | 5 |
| Brach/thor cath 1st CPT 36215 | $867.00 | $1,700.00 | $1,716.00 – $5,318.00 | 3 |
| Brach/thor cath 2nd CPT 36216 | $1,559.07 | $3,057.00 | $1,716.00 – $5,318.00 | 3 |
| Brach/thor cath 3rd CPT 36217 | $1,425.45 | $2,795.00 | $1,716.00 – $5,318.00 | 3 |
| Brach/thor cath addl CPT 36218 | $584.97 | $1,147.00 | $375.68 – $4,042.00 | 3 |
| Brachy source i-125 injection HCPCS C2638 | not published | not published | $34.55 – $35.26 | 2 |
| Brachy source iodine-125 nonstranded HCPCS C2639 | not published | not published | $35.91 – $36.64 | 2 |
| Brachy source palladium HCPCS C2640 | $273.11 | $535.50 | $86.49 – $88.26 | 2 |
| Brachy source palladium-103 nonstranded HCPCS C2641 | $260.10 | $510.00 | $63.19 – $64.48 | 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.