Banner Lassen Medical Center
1800 Spring Ridge Drive, Susanville, CA · Banner Health · · NPI 1538197231
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 |
|---|---|---|---|---|
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $7.51 | $12.00 | $0.78 – $11.64 | 12 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $35.06 | $56.00 | $3.28 – $27.08 | 12 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $4.38 | $7.00 | $2.87 – $27.03 | 12 |
| Graft axiofill 1000mg HCPCS J3590 | $32.90 | $47.20 | $2.77 – $6.56 | 11 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $26,589.03 | $43,804.00 | $1,104.95 – $2,614.15 | 11 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $33,235.68 | $54,754.00 | $243.54 – $576.18 | 11 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $22,601.04 | $37,234.00 | $128.33 – $303.61 | 11 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $687.12 | $1,132.00 | $348.50 – $824.50 | 11 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $4,317.49 | $9,265.00 | $68.06 – $161.02 | 11 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $1,675.74 | $3,596.00 | $128.33 – $303.61 | 11 |
| Gw stiffened micro access kit HCPCS C1894 | $3,670.22 | $7,876.00 | $39.36 – $93.12 | 11 |
| Hands-On Manual Therapy (each 15 minutes) CPT 97140 | $115.68 | $160.00 | $36.65 – $155.20 | 12 |
| Hand X-ray CPT 73130 | $259.12 | $395.00 | $41.48 – $383.15 | 12 |
| Hand X-ray (2 views, both hands) CPT 73120 | $248.62 | $379.00 | $28.55 – $367.63 | 12 |
| Haptoglobin quantitative CPT 83010 | $5.63 | $9.00 | $2.52 – $18.13 | 12 |
| Hba1/hba2 full gene sequence CPT 81259 | $368.58 | $657.00 | $120.00 – $792.00 | 12 |
| Hcg qualitative CPT 84703 | $14.40 | $23.00 | $1.50 – $22.31 | 12 |
| Hcg quantitative CPT 84702 | $28.80 | $46.00 | $3.01 – $21.85 | 12 |
| Hc i-131 sodium iodide cap dx per mci HCPCS A9528 | $116.40 | $167.00 | $50.26 – $161.99 | 12 |
| Hc nm kidney imaging with flow CPT 78701 | $516.67 | $770.00 | $80.37 – $746.90 | 12 |
| Head CT scan (with and without contrast) CPT 70470 | $1,068.36 | $1,901.00 | $35.60 – $1,843.97 | 12 |
| Head CT scan (with contrast) CPT 70460 | $890.21 | $1,584.00 | $35.60 – $1,536.48 | 12 |
| Head CT scan (without contrast) CPT 70450 | $712.05 | $1,267.00 | $21.27 – $1,228.99 | 12 |
| Heel (Calcaneus) X-ray (both feet) CPT 73650 | $167.28 | $255.00 | $31.38 – $247.35 | 12 |
| Helicobacter pylori antibody igm CPT 86677 | $17.84 | $28.00 | $3.37 – $27.16 | 12 |
| Hematocrit CPT 85014 | $10.13 | $17.00 | $0.47 – $7.76 | 12 |
| Hemoglobin CPT 85018 | $10.13 | $17.00 | $0.47 – $7.76 | 12 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $73.87 | $118.00 | $1.64 – $114.46 | 12 |
| Hemoglobin plasma CPT 83051 | $8.76 | $14.00 | $1.46 – $13.58 | 12 |
| Hemophilus influenza antibdy CPT 86684 | $7.64 | $12.00 | $3.17 – $23.23 | 12 |
| Heparin assay CPT 85520 | $38.74 | $65.00 | $2.62 – $40.74 | 12 |
| Hepatitis a antibody igm CPT 86709 | $17.84 | $28.00 | $2.25 – $27.16 | 12 |
| Hepatitis b core antibody igm CPT 86705 | $61.15 | $96.00 | $2.05 – $17.11 | 12 |
| Hepatitis b core antibody total CPT 86704 | $23.57 | $37.00 | $2.05 – $17.67 | 12 |
| Hepatitis b surface antibody CPT 86706 | $3.18 | $5.00 | $2.05 – $15.69 | 12 |
| Hepatitis c antibody CPT 86803 | $60.52 | $95.00 | $2.46 – $20.74 | 12 |
| Hernia Repair (Inguinal) CPT 49505 | not published | not published | $113.65 – $113.65 | 1 |
| Herpes simplex type 1 antibody igg CPT 86695 | $25.48 | $40.00 | $1.23 – $19.34 | 12 |
| Herpes simplex type 2 antibody igg CPT 86696 | $37.58 | $59.00 | $2.05 – $28.38 | 12 |
| Herpes simplex virus isolation CPT 87255 | $15.07 | $27.00 | $6.77 – $49.66 | 12 |
| Heterophile antibodies screening CPT 86308 | $10.19 | $16.00 | $1.04 – $7.41 | 12 |
| Hhv-6 dna quant CPT 87533 | $36.83 | $66.00 | $8.35 – $64.02 | 12 |
| Hip and Pelvis X-ray (2 views, both hips) CPT 73521 | $371.95 | $567.00 | $21.27 – $549.99 | 12 |
| Hip and Pelvis X-ray (3 to 4 views, both hips) CPT 73522 | $484.13 | $738.00 | $21.27 – $715.86 | 12 |
| Hip and Pelvis X-ray (single view, left side) CPT 73501 | $144.32 | $220.00 | $43.74 – $213.40 | 12 |
| Hip X-ray CPT 73502 | $410.00 | $625.00 | $61.51 – $606.25 | 12 |
| Histamine CPT 83088 | $17.53 | $28.00 | $5.91 – $43.31 | 12 |
| Hla i & ii type verify lr CPT 81371 | $84.15 | $150.00 | $61.50 – $432.35 | 12 |
| Hla ii typing 1 loc hr CPT 81382 | $12.34 | $22.00 | $9.02 – $181.40 | 12 |
| Hla i low res one antigen equiv ea CPT 81374 | $66.76 | $119.00 | $14.87 – $115.43 | 12 |
| Hla i typing 1 locus hr CPT 81380 | $90.88 | $162.00 | $35.45 – $259.96 | 12 |
| Hla i typing high res 1 allele grp ea CPT 81381 | $78.54 | $140.00 | $33.98 – $169.90 | 12 |
| Hla i typing low res one locus ea CPT 81373 | $81.35 | $145.00 | $25.49 – $168.20 | 12 |
| Hla typing dr/dq CPT 86816 | $77.71 | $122.00 | $6.03 – $118.34 | 12 |
| Homocysteine CPT 83090 | $5.01 | $8.00 | $3.28 – $24.73 | 12 |
| Homovanillic acid (hva) CPT 83150 | $10.64 | $17.00 | $4.48 – $18.81 | 12 |
| Human epididymis protein 4 (he4) CPT 86305 | $29.30 | $46.00 | $4.16 – $44.62 | 12 |
| Hyaluronidase, human recombinant 150 unit/ml injection solution HCPCS J3473 | $0.06 | $0.24 | $0.10 – $0.23 | 11 |
| Hydromorphone injection HCPCS J1170 | $0.25 | $0.96 | $0.39 – $0.93 | 11 |
| Hysterorrhaphy of ruptured uterus 59350 CPT 59350 | not published | not published | $234.10 – $234.10 | 1 |
| Hysterosalpingography s&i CPT 74740 | $681.58 | $1,039.00 | $48.34 – $1,007.83 | 12 |
| Hysteroscopy ablation CPT 58563 | not published | not published | $2,804.97 – $2,804.97 | 1 |
| Hysteroscopy biopsy CPT 58558 | not published | not published | $2,109.28 – $2,109.28 | 1 |
| Hysteroscopy dx sep proc CPT 58555 | not published | not published | $265.86 – $265.86 | 1 |
| Hysteroscopy remove fb CPT 58562 | not published | not published | $662.99 – $662.99 | 1 |
| I-123 sod iodide diag per 100 uci HCPCS A9516 | $193.07 | $277.00 | $113.57 – $268.69 | 12 |
| I-131 sod iodide sol diag per mci HCPCS A9529 | $297.62 | $427.00 | $175.07 – $414.19 | 11 |
| Iadna legionella pneumophila amplified probe tq CPT 87541 | $22.32 | $40.00 | $7.02 – $51.46 | 12 |
| Icd cobalt xt dr MRI is1 df1 HCPCS C1721 | $91,604.36 | $131,404.00 | $26,938.64 – $63,732.88 | 11 |
| Icd crtd cobalt hf MRI is1 df1 HCPCS C1882 | $74,444.91 | $122,644.00 | $25,141.20 – $59,480.40 | 11 |
| Icd crtp serena MRI HCPCS C2621 | $30,536.64 | $43,804.00 | $2,503.05 – $5,921.85 | 11 |
| Icd reliance df4 ib 64cm HCPCS C1895 | $19,942.38 | $32,854.00 | $1,104.95 – $2,614.15 | 11 |
| Igh gene rearrange amp meth CPT 81261 | $21.32 | $38.00 | $15.58 – $39.60 | 11 |
| Igh@ var region somatic mutation analy CPT 81263 | $126.23 | $225.00 | $58.90 – $218.25 | 11 |
| Igk rearrangeabn clonal pop CPT 81264 | $75.74 | $135.00 | $34.55 – $130.95 | 11 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $36.71 | $87.00 | $35.67 – $100.02 | 12 |
| Ihc/icc per specimen each multiplex antibody stain CPT 88344 | $410.61 | $973.00 | $71.94 – $739.14 | 12 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $12.66 | $30.00 | $12.30 – $88.75 | 12 |
| Immune complex assay CPT 86332 | $10.19 | $16.00 | $4.87 – $35.74 | 12 |
| Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution HCPCS J1566 | $1,635.38 | $3,691.60 | $16.34 – $3,580.85 | 12 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $7.64 | $12.00 | $4.16 – $30.52 | 12 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $7.64 | $12.00 | $4.16 – $30.52 | 12 |
| Immunodiff gel qual ea antigen/ab CPT 86331 | $4.46 | $7.00 | $2.40 – $9.73 | 12 |
| Immunodiffusion nes CPT 86329 | $3.18 | $5.00 | $2.05 – $20.61 | 12 |
| Immunofixation electrophoresis serum CPT 86334 | $15.29 | $24.00 | $4.47 – $32.77 | 12 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | $58.66 | $139.00 | $56.99 – $134.83 | 12 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | $15.61 | $37.00 | $15.17 – $92.48 | 12 |
| Immunoglobulin assay CPT 86023 | $118.48 | $186.00 | $2.49 – $180.42 | 12 |
| Implant cartilage 10mm synthetic HCPCS L8699 | $58,492.95 | $96,364.00 | $65.19 – $154.23 | 11 |
| Implant ureth bulk agent HCPCS L8606 | $1,868.35 | $3,078.00 | $68.06 – $241.05 | 12 |
| Incision & drainage hematoma/seroma/fluid collection CPT 10140 | not published | not published | $82.32 – $82.32 | 1 |
| Incision of spinal nerve 64772 CPT 64772 | not published | not published | $133.91 – $133.91 | 1 |
| Incision of tendon sheath CPT 25000 | not published | not published | $61.43 – $61.43 | 1 |
| Incision tendon sheath CPT 26055 | not published | not published | $347.69 – $347.69 | 1 |
| Infect ag drug suscept pheno predict CPT 87900 | $133.36 | $239.00 | $26.07 – $231.83 | 12 |
| Infect ag eia influenza a or b ea CPT 87400 | $23.99 | $43.00 | $2.83 – $41.71 | 12 |
| Infect ag genotype na cytomegalovirus CPT 87910 | $306.34 | $549.00 | $38.58 – $532.53 | 12 |
| Infect ag genotype na dna hepatitis b CPT 87912 | $90.95 | $163.00 | $38.58 – $158.11 | 12 |
| Infect ag genotype na hiv-1 other region CPT 87906 | $63.61 | $114.00 | $25.75 – $188.79 | 12 |
| Infect ag genotype na hiv-1 revr trn/prt CPT 87901 | $75.89 | $136.00 | $51.49 – $377.59 | 12 |
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.