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 |
|---|---|---|---|---|
| Suspension of testis CPT 54620 | not published | not published | $3,423.00 – $6,732.00 | 5 |
| Suspension of uterus CPT 58410 | not published | not published | $2,238.00 – $6,732.00 | 3 |
| Suspension of uterus 58400 CPT 58400 | not published | not published | $2,238.00 – $24,668.00 | 4 |
| Sutr lg intestine 1/mult perf without colostomy 44604 CPT 44604 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Suture bile duct injury 47900 CPT 47900 | not published | not published | $2,238.00 – $9,773.00 | 3 |
| Svc venogram s&i CPT 75827 | $3,893.34 | $7,634.00 | $1,008.82 – $3,146.68 | 4 |
| Sweat collection by iontophoresis CPT 89230 | not published | not published | $17.38 – $110.55 | 4 |
| Sympathectomy cervical CPT 64802 | not published | not published | $2,717.15 – $4,737.00 | 5 |
| Sympathectomy digital artery CPT 64820 | not published | not published | $2,717.15 – $6,732.00 | 5 |
| Sympathectomy lumbar CPT 64818 | not published | not published | $2,995.00 – $9,773.00 | 3 |
| Sympathectomy supfc palmar CPT 64823 | not published | not published | $4,233.00 – $11,377.00 | 4 |
| Sympathectomy thoracolumbar CPT 64809 | not published | not published | $2,995.00 – $9,773.00 | 3 |
| Synojoynt, inj., 1 mg HCPCS J7331 | not published | not published | $16.86 – $33.29 | 3 |
| Synvisc or synvisc-one HCPCS J7325 | not published | not published | $6.82 – $20.96 | 4 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $1.49 | $2.92 | $4.31 – $38.64 | 4 |
| System cardiomems hosp electronics HCPCS C2624 | $72,374.00 | $141,909.80 | not published | 0 |
| System pacing micra av HCPCS C1786 | $43,113.87 | $84,537.00 | not published | 0 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $21,860.64 | $42,864.00 | not published | 0 |
| System sealant biosentry tract HCPCS C2613 | $1,199.52 | $2,352.00 | not published | 0 |
| T3 (triiodothyronine) free CPT 84481 | $178.50 | $350.00 | $16.60 – $148.72 | 4 |
| T3 (triiodothyronine) total CPT 84480 | $63.50 | $124.50 | $13.90 – $124.38 | 4 |
| T4 (thyroxine) free CPT 84439 | $157.59 | $309.00 | $8.84 – $79.12 | 4 |
| T4 (thyroxine) total CPT 84436 | $148.92 | $292.00 | $6.73 – $60.33 | 4 |
| Tacrol astagraf ex rel oral HCPCS J7508 | not published | not published | $0.56 – $1.23 | 3 |
| Tacrol envarsus ex rel oral HCPCS J7503 | not published | not published | $1.39 – $3.89 | 3 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $24.17 | $47.40 | $0.39 – $5.47 | 3 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | $787.16 | $1,543.46 | $157.84 – $548.38 | 4 |
| Tacrolimus therapeutic drug level CPT 80197 | $349.86 | $686.00 | $13.46 – $130.23 | 4 |
| Tafasitamab-cxix 200 mg intravenous solution HCPCS J9349 | not published | not published | $13.88 – $29.95 | 4 |
| Tah rad debulk/lymph remove 58954 CPT 58954 | not published | not published | $3,423.00 – $12,568.00 | 3 |
| Tah rad dissect for debulk 58953 CPT 58953 | not published | not published | $3,423.00 – $12,568.00 | 3 |
| Tah w/mmk 58152 CPT 58152 | not published | not published | $2,238.00 – $25,815.00 | 4 |
| Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection HCPCS J9325 | not published | not published | $62.97 – $151.32 | 4 |
| Talquetamab-tgvs 2 mg/ml subcutaneous solution HCPCS J3055 | not published | not published | $73.38 – $150.50 | 4 |
| Talymed HCPCS Q4127 | not published | not published | $44.92 – $176.69 | 4 |
| Tamoxifen 10 mg tabs 60 each bottle HCPCS S0187 | not published | not published | $4.05 – $4.05 | 1 |
| Tap block bilat cont infusion 64489 CPT 64489 | not published | not published | $1,716.00 – $15,202.00 | 4 |
| Tap block uni by cont infusion 64487 CPT 64487 | not published | not published | $1,716.00 – $15,202.00 | 4 |
| Target gsa panel hmtlmph neop CPT 81450 | not published | not published | $744.34 – $18,093.86 | 4 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | not published | not published | $2,861.21 – $18,093.86 | 4 |
| Target gsa panel organ neop CPT 81445 | not published | not published | $585.95 – $18,093.86 | 4 |
| Tarlatamab-dlle 10 mg intravenous solution HCPCS J9026 | $34,329.38 | $67,312.50 | $1,536.36 – $3,377.16 | 4 |
| Tas congenital car anomal CPT 33741 | not published | not published | $2,238.00 – $12,568.00 | 3 |
| Tattooing/intraderm 6.1-20.0 sq cm 11921 CPT 11921 | not published | not published | $691.00 – $4,042.00 | 5 |
| Tavr perq femoral CPT 33361 | $21,679.08 | $42,508.00 | $5,530.00 – $12,568.00 | 3 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | not published | not published | $0.24 – $1.21 | 4 |
| Tbp gene detc abnor alleles CPT 81344 | not published | not published | $134.26 – $715.60 | 4 |
| Tbs dxa cal w/i&r fx risk CPT 77089 | not published | not published | $66.45 – $282.85 | 3 |
| Tbs i&r fx rsk qhp CPT 77092 | not published | not published | $16.61 – $69.18 | 3 |
| Tbs techl calculation only CPT 77091 | not published | not published | $121.09 – $178.68 | 4 |
| Tbs techl prep&transmis data CPT 77090 | not published | not published | $14.36 – $132.18 | 4 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | not published | not published | $98.00 – $412.96 | 4 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $607.41 | $1,191.00 | $60.74 – $532.08 | 4 |
| Tc-99m apcitide diag HCPCS A9504 | not published | not published | $596.16 – $1,094.63 | 2 |
| Tc-99m arcitumomab HCPCS A9568 | not published | not published | $1,740.45 – $1,740.45 | 1 |
| Tc-99m bicisate HCPCS A9557 | not published | not published | $507.04 – $1,470.17 | 4 |
| Tc-99m depreotide HCPCS A9536 | not published | not published | $1,006.85 – $1,667.00 | 2 |
| Tc-99m disofenin HCPCS A9510 | not published | not published | $71.54 – $128.66 | 2 |
| Tc-99m exame autol wbc diag per dose HCPCS A9569 | not published | not published | $915.45 – $2,236.69 | 4 |
| Tc-99m exametazime diag HCPCS A9521 | not published | not published | $1,117.80 – $1,725.03 | 2 |
| Tc-99m graphite crucible HCPCS A9506 | not published | not published | $322.03 – $706.49 | 4 |
| Tc-99m labeled rbc HCPCS A9560 | not published | not published | $151.03 – $226.72 | 2 |
| Tc-99m maa HCPCS A9540 | not published | not published | $28.52 – $63.30 | 2 |
| Tc-99m mebrofenin HCPCS A9537 | not published | not published | $78.88 – $243.94 | 2 |
| Tc-99m medronate HCPCS A9503 | not published | not published | $127.26 – $193.59 | 2 |
| Tc-99m mertiatide HCPCS A9562 | not published | not published | $590.21 – $1,651.69 | 2 |
| Tc-99m non-heu per study dose HCPCS Q9969 | not published | not published | $12.90 – $12.90 | 1 |
| Tc-99m oxidronate HCPCS A9561 | not published | not published | $43.49 – $108.49 | 2 |
| Tc-99m pentetate dtpa HCPCS A9539 | not published | not published | $21.53 – $59.81 | 2 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | not published | not published | $43.82 – $43.82 | 1 |
| Tc-99m pertechnetate per mci HCPCS A9512 | not published | not published | $2.29 – $22.94 | 2 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | not published | not published | $32.72 – $87.63 | 2 |
| Tc-99m sestamibi p study dose HCPCS A9500 | not published | not published | $152.74 – $968.75 | 2 |
| Tc-99m succimer (dmsa) HCPCS A9551 | not published | not published | $167.76 – $1,431.23 | 4 |
| Tc-99m sulfur colloid HCPCS A9541 | not published | not published | $70.48 – $1,615.51 | 2 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | not published | not published | $150.23 – $339.38 | 2 |
| Tc-99m tilmanocept diag HCPCS A9520 | not published | not published | $323.95 – $323.95 | 1 |
| Tca peel dermal 15789 CPT 15789 | not published | not published | $691.00 – $1,716.00 | 4 |
| Tcd emboli detect w/inj CPT 93893 | not published | not published | $145.47 – $1,563.44 | 3 |
| Tcd emboli detect without inj CPT 93892 | not published | not published | $145.47 – $1,607.28 | 3 |
| Tcd vasoreactivity study CPT 93890 | not published | not published | $1,546.48 – $1,546.48 | 1 |
| T-cell depletion of harvest CPT 38210 | not published | not published | $613.88 – $4,042.00 | 5 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $159.96 | $313.65 | $46.04 – $346.31 | 4 |
| T cells absolute cd 4 count CPT 86361 | $65.10 | $127.65 | $26.24 – $236.35 | 4 |
| T cells total count CPT 86359 | $47.89 | $93.91 | $36.98 – $331.66 | 4 |
| Tcranial magn stim tx deli CPT 90868 | not published | not published | $300.45 – $8,818.97 | 4 |
| Tcranial magn stim tx plan CPT 90867 | not published | not published | $300.45 – $18,267.04 | 4 |
| Tcran magn stim redetemine CPT 90869 | not published | not published | $300.45 – $2,238.00 | 3 |
| Tdh sdrl/ventr pnxr CPT 61105 | not published | not published | $2,238.00 – $6,732.00 | 3 |
| Teaec w/wo patch graft iliofemoral CPT 35355 | $8,951.52 | $17,552.00 | $2,238.00 – $9,773.00 | 3 |
| Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution HCPCS J9274 | not published | not published | $218.04 – $461.73 | 4 |
| Tee w or without fol w/cont,cong HCPCS C8926 | not published | not published | $1,090.80 – $1,737.16 | 3 |
| Tee w or without fol w/cont, mon HCPCS C8927 | not published | not published | $1,090.80 – $1,113.06 | 2 |
| Telavancin injection HCPCS J3095 | not published | not published | $2.97 – $15.24 | 4 |
| Telethx isodose plan cplx CPT 77307 | $6,722.31 | $13,181.00 | $521.01 – $1,111.96 | 3 |
| Telethx isodose plan simple CPT 77306 | $3,426.69 | $6,719.00 | $521.01 – $607.06 | 3 |
| Temozolomide HCPCS J8700 | $77.09 | $151.15 | $0.77 – $4.27 | 3 |
| Temozolomide 100 mg intravenous solution HCPCS J9328 | not published | not published | $6.77 – $22.38 | 4 |
| Temperature gradient studies CPT 93740 | not published | not published | $40.12 – $182.70 | 3 |
| Temple bne implnt w/stimulat CPT 69715 | not published | not published | $9,773.00 – $89,248.00 | 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.