UKIAH ADVENTIST HOSPITAL
275 Hospital Dr, Ukiah, CA · Adventisthealth · · NPI 1235120676
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 |
|---|---|---|---|---|
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $200.00 | $1,000.00 | $66.41 – $708.21 | 16 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | $185.80 | $929.00 | $30.00 – $318.07 | 16 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | $149.40 | $747.00 | $55.00 – $252.46 | 16 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | $174.20 | $871.00 | $25.00 – $298.81 | 16 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | $148.00 | $740.00 | $75.20 – $504.83 | 6 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | $168.00 | $840.00 | $90.47 – $504.83 | 6 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | $104.40 | $522.00 | $5.00 – $175.27 | 16 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | $160.20 | $801.00 | $35.00 – $304.68 | 16 |
| Destruction premal lesions 15/> 17004 CPT 17004 | $119.60 | $598.00 | $3.00 – $559.97 | 17 |
| Destruction rectal tumor 45190 CPT 45190 | $484.60 | $2,423.00 | $66.41 – $995.10 | 16 |
| Destruction vag lesions complex 57065 CPT 57065 | $172.40 | $862.00 | $66.41 – $318.37 | 16 |
| Destruction vag lesions simple 57061 CPT 57061 | $118.60 | $593.00 | $58.78 – $187.58 | 16 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | $547.60 | $2,738.00 | $66.41 – $2,842.14 | 17 |
| Determine refractive state CPT 92015 | $13.20 | $66.00 | $22.27 – $504.83 | 14 |
| Developmental screen/score/document 96110 CPT 96110 | $110.60 | $553.00 | $9.81 – $634.00 | 12 |
| Devel tst phys/qhp 1st hr CPT 96112 | $59.40 | $297.00 | $66.41 – $212.61 | 16 |
| Device intraute mirena HCPCS J7298 | $814.47 | $4,072.37 | $1,101.70 – $5,375.87 | 10 |
| Device sut capio slim opn HCPCS C2631 | $875.40 | $4,377.00 | $4,377.00 – $4,377.00 | 2 |
| Dev interrog remote 1/2/mlt CPT 93295 | $30.00 | $150.00 | $36.70 – $652.68 | 18 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $105.80 | $529.00 | $9.54 – $585.41 | 18 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $2.80 | $14.00 | $0.01 – $4.00 | 10 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $17.37 | $86.85 | $0.09 – $17.00 | 10 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $11.99 | $59.93 | $2.62 – $107.90 | 8 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $12.30 | $61.49 | $4.84 – $61.49 | 8 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $9.45 | $47.26 | $3.50 – $61.48 | 8 |
| Dextrose 5 % IV bolus HCPCS J7070 | $11.42 | $57.10 | $5.88 – $66.20 | 8 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $82.20 | $411.00 | $19.62 – $299.79 | 11 |
| Diabetes (HbA1c) Test CPT 83036 | $36.20 | $181.00 | $3.79 – $130.92 | 18 |
| Diabetes training group per 30 min g0109 HCPCS G0136 | $9.80 | $49.00 | $49.00 – $504.83 | 6 |
| Diab manage trn ind/group HCPCS G0109 | $8.00 | $40.00 | $17.59 – $504.83 | 6 |
| Diag laparo separate proc 49320 CPT 49320 | $224.20 | $1,121.00 | $46.91 – $505.76 | 16 |
| Diagnostic anoscopy CPT 46601 | $64.20 | $321.00 | $10.00 – $217.57 | 16 |
| Diagnostic anoscopy & biopsy CPT 46607 | $84.40 | $422.00 | $30.00 – $311.73 | 16 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $83.00 | $415.00 | $10.00 – $183.27 | 17 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $63.40 | $317.00 | $42.97 – $134.66 | 16 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $91.20 | $456.00 | $62.13 – $274.96 | 17 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $216.20 | $1,081.00 | $47.18 – $1,259.97 | 18 |
| Diagnostic Mammogram (one breast) CPT 77065 | $168.00 | $840.00 | $38.35 – $984.24 | 18 |
| Diagnostic radio unlisted proc CPT 76499 | $10.00 | $50.00 | $41.25 – $66.41 | 3 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $129.60 | $648.00 | $45.00 – $3,212.39 | 16 |
| Dialysis one evaluation CPT 90945 | $292.20 | $1,461.00 | $103.51 – $1,034.59 | 8 |
| Dialysis repeated eval CPT 90947 | $78.80 | $394.00 | $106.74 – $929.49 | 8 |
| Diathermy eg microwave CPT 97024 | $19.80 | $99.00 | $7.71 – $634.00 | 14 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $54.68 | $273.42 | $5.47 – $21.92 | 10 |
| Dicyclomine injection HCPCS J0500 | $42.80 | $214.02 | $22.66 – $214.02 | 8 |
| Diffusing capacity CPT 94729 | $118.40 | $592.00 | $9.56 – $427.07 | 18 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $12.74 | $63.69 | $8.71 – $63.69 | 8 |
| Digoxin total therapeutic drug level CPT 80162 | $58.00 | $290.00 | $13.28 – $179.04 | 11 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $24.20 | $121.00 | $42.34 – $184.00 | 9 |
| Dilate biliary duct/ampulla CPT 47542 | $89.40 | $447.00 | $66.41 – $837.93 | 16 |
| Dilate esophagus CPT 43453 | $59.40 | $297.00 | $15.00 – $480.94 | 16 |
| Dilate esophagus 1/mult pass CPT 43450 | $134.40 | $672.00 | $15.00 – $255.80 | 16 |
| Dilate tear duct opening CPT 68801 | $109.80 | $549.00 | $40.00 – $615.36 | 17 |
| Dilate urethra stricture CPT 53600 | $72.80 | $364.00 | $10.00 – $344.16 | 17 |
| Dilate urethra stricture CPT 53601 | $60.80 | $304.00 | $47.57 – $183.27 | 17 |
| Dilate urethra stricture CPT 53605 | $42.80 | $214.00 | $29.41 – $108.22 | 16 |
| Dilate urethra stricture CPT 53621 | $114.40 | $572.00 | $10.00 – $344.16 | 17 |
| Dilation/female urethra/initial 53660 CPT 53660 | $54.00 | $270.00 | $15.00 – $177.25 | 17 |
| Dilation of anal sphincter CPT 45905 | $118.80 | $594.00 | $20.00 – $249.63 | 16 |
| Dilation of cervical canal 57800 CPT 57800 | $54.40 | $272.00 | $34.46 – $99.20 | 16 |
| Dilation of rectal stricture 45910 CPT 45910 | $134.20 | $671.00 | $45.00 – $289.20 | 16 |
| Dilation of urethra CPT 53661 | $53.20 | $266.00 | $36.19 – $183.27 | 17 |
| Dilation of vagina CPT 57400 | $88.20 | $441.00 | $47.00 – $220.20 | 16 |
| Dilation salivary duct 42650 CPT 42650 | $52.80 | $264.00 | $30.16 – $119.85 | 16 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | $199.80 | $999.00 | $10.00 – $960.52 | 17 |
| Dilator fascial 10fx20cm HCPCS C2627 | $635.60 | $3,178.00 | $455.00 – $455.00 | 2 |
| Dilat xst trc ndurlgc px CPT 50436 | $1,470.80 | $7,354.00 | $66.41 – $4,855.61 | 17 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | $8.00 | $40.00 | $0.06 – $40.00 | 4 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $32.80 | $164.00 | $154.50 – $1,348.16 | 15 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $7.85 | $39.25 | $0.70 – $9.46 | 10 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | $22.40 | $112.00 | $26.03 – $83.83 | 9 |
| Disability dlco CPT 94727 | $131.00 | $655.00 | $12.33 – $297.43 | 18 |
| Disaccharidases CPT 82657 | $67.36 | $336.80 | $17.74 – $242.50 | 11 |
| Discography cerv/thor spine CPT 72285 | $44.00 | $220.00 | $58.87 – $3,216.93 | 16 |
| Dise eval slp do brth flx dx CPT 42975 | $66.80 | $334.00 | $83.53 – $175.02 | 13 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | $543.20 | $2,716.00 | $30.00 – $1,248.35 | 16 |
| Division of fallopian tube 58605 CPT 58605 | $231.60 | $1,158.00 | $66.41 – $528.26 | 16 |
| Dna antibody native/double stranded CPT 86225 | $1.60 | $8.00 | $8.00 – $185.30 | 11 |
| Dna gardnerella CPT 87510 | $49.60 | $248.00 | $17.83 – $261.65 | 11 |
| Dna trichomonas CPT 87660 | $90.60 | $453.00 | $17.83 – $271.37 | 11 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $30.51 | $152.55 | $16.04 – $152.55 | 8 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | $7.80 | $39.00 | $0.60 – $128.54 | 10 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $14.83 | $74.15 | $1.60 – $74.15 | 8 |
| Doppler echo complete CPT 93320 | $319.60 | $1,598.00 | $17.87 – $808.39 | 18 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $33.40 | $167.00 | $66.41 – $349.32 | 16 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $690.40 | $3,452.00 | $21.15 – $1,072.13 | 18 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $208.20 | $1,041.00 | $11.62 – $568.16 | 18 |
| Dostarlimab-gxly 50 mg/ml intravenous solution HCPCS J9272 | $3,989.11 | $19,945.54 | $243.82 – $1,031.77 | 10 |
| Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 | $31.46 | $157.29 | $5.56 – $329.73 | 8 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $31.95 | $159.76 | $0.20 – $159.76 | 4 |
| Dpyd gene common variants CPT 81232 | $34.96 | $174.81 | $139.85 – $2,811.83 | 11 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $86.60 | $433.00 | $49.52 – $264.30 | 16 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $194.00 | $970.00 | $30.00 – $975.44 | 17 |
| Drainage external ear complex 69005 CPT 69005 | $485.00 | $2,425.00 | $66.41 – $2,275.05 | 17 |
| Drainage external ear simple 69000 CPT 69000 | $131.60 | $658.00 | $30.00 – $276.36 | 16 |
| Drainage lymph node lesion 38305 CPT 38305 | $341.60 | $1,708.00 | $66.41 – $712.14 | 16 |
| Drainage mouth roof lesion CPT 42000 | $77.80 | $389.00 | $15.00 – $242.64 | 16 |
| Drainage of arm bursa 23931 CPT 23931 | $215.40 | $1,077.00 | $40.00 – $466.37 | 16 |
| Drainage of bone lesion CPT 26992 | $698.80 | $3,494.00 | $30.00 – $1,546.83 | 16 |
| Drainage of bone lesion CPT 27303 | $451.00 | $2,255.00 | $55.00 – $1,009.88 | 16 |
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.