ST HELENA HOSPITAL
10 Woodland Rd Saint Helena CA 94574|525 Oregon St, Vallejo, CA · Adventisthealth · · NPI 1720078082
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 |
|---|---|---|---|---|
| Lap sleeve gastrectomy CPT 43775 | $581.70 | $3,878.00 | $1,006.49 – $3,285.64 | 19 |
| Lap tot proctocolectomy 44210 CPT 44210 | $973.20 | $6,488.00 | $135.00 – $4,463.07 | 19 |
| Laryngoscopy with biopsy CPT 31576 | $68.40 | $456.00 | $35.00 – $407.93 | 19 |
| Lead acuity x4 spiral l 86cm HCPCS C1900 | $3,375.00 | $22,500.00 | $2,671.25 – $2,671.25 | 1 |
| Lead capillary CPT 83655 | $18.15 | $121.00 | $0.78 – $139.83 | 13 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $759.30 | $5,062.00 | $1,784.00 – $1,784.00 | 1 |
| Lead tachy durata sj4 58cm HCPCS C1777 | $4,050.00 | $27,000.00 | $282.00 – $282.00 | 1 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $555.45 | $3,703.00 | $34.85 – $1,103.61 | 23 |
| Leishmania antibody CPT 86717 | $1.63 | $10.89 | $1.33 – $141.70 | 13 |
| Lens, intraocular (new tech) HCPCS C1780 | $160.58 | $1,070.50 | $714.50 – $714.50 | 1 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $483.00 | $3,220.00 | $575.00 – $575.00 | 1 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $1,119.45 | $7,463.00 | $145.73 – $262.31 | 7 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $53.59 | $357.25 | $145.73 – $262.31 | 7 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $135.17 | $901.13 | $7.38 – $248.63 | 10 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $5,447.39 | $36,315.93 | $160.34 – $1,584.34 | 17 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $3,209.60 | $21,397.35 | $994.94 – $4,802.14 | 17 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $41.57 | $277.13 | $0.09 – $188.45 | 10 |
| Levetiracetam therapeutic drug level CPT 80177 | $1.77 | $11.78 | $1.56 – $88.19 | 13 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $15.48 | $103.18 | $1.50 – $78.71 | 10 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $135.02 | $900.15 | $13.16 – $900.15 | 7 |
| Liberta rc ipg HCPCS C1820 | $18,939.75 | $126,265.00 | $126,265.00 – $126,265.00 | 1 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $18.25 | $121.67 | $0.02 – $1.14 | 7 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $3.30 | $22.00 | $0.02 – $22.00 | 7 |
| Lidocaine therapeutic drug level CPT 80176 | $35.70 | $238.00 | $14.54 – $169.61 | 13 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | $114.15 | $761.00 | $21.00 – $554.83 | 19 |
| Limited visual field xm CPT 92081 | $50.85 | $339.00 | $47.26 – $141.06 | 8 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $29.41 | $196.08 | $5.45 – $196.08 | 10 |
| Lipase CPT 83690 | $75.90 | $506.00 | $0.42 – $79.48 | 13 |
| Lipoprotein blood high res frac & quant CPT 83701 | $6.29 | $41.90 | $14.19 – $280.51 | 13 |
| Lipoprotein direct measurement hdl CPT 83718 | $40.50 | $270.00 | $0.55 – $94.49 | 13 |
| Lipoprotein direct measurement ldl CPT 83721 | $46.35 | $309.00 | $0.86 – $108.95 | 13 |
| Lithium therapeutic drug level CPT 80178 | $63.15 | $421.00 | $0.39 – $76.29 | 13 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $1,977.90 | $13,186.00 | $97.92 – $233.53 | 19 |
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | $667.50 | $4,450.00 | $30.00 – $2,407.74 | 19 |
| Liver Function Test CPT 80076 | $84.60 | $564.00 | $1.04 – $94.41 | 13 |
| Liver/spleen imag static only CPT 78215 | $524.40 | $3,496.00 | $25.04 – $719.58 | 24 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $548.70 | $3,658.00 | $29.20 – $855.25 | 24 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $0.95 | $6.36 | $0.72 – $6.30 | 10 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $11.25 | $75.00 | $1.85 – $61.32 | 10 |
| Low back disk surgery CPT 63030 | $781.95 | $5,213.00 | $473.00 – $2,382.07 | 19 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,753.65 | $11,691.00 | $9.26 – $1,346.83 | 24 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,494.75 | $9,965.00 | $8.84 – $1,080.85 | 24 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,283.55 | $8,557.00 | $8.40 – $1,060.00 | 24 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,149.20 | $14,328.00 | $17.09 – $3,089.98 | 24 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $1,627.65 | $10,851.00 | $12.99 – $1,882.70 | 24 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $1,256.85 | $8,379.00 | $10.81 – $1,739.58 | 24 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $232.05 | $1,547.00 | $1.60 – $166.12 | 24 |
| Lumbar diskogram s&i CPT 72295 | $1,678.80 | $11,192.00 | $6.11 – $2,594.12 | 24 |
| Lumbar Spinal Fusion (single level) CPT 22612 | $878.85 | $5,859.00 | $238.64 – $3,587.38 | 19 |
| Lung function test (mbc/mvv) CPT 94200 | $47.85 | $319.00 | $23.52 – $141.06 | 11 |
| Lung Function Test (Spirometry) CPT 94010 | $187.80 | $1,252.00 | $35.29 – $516.32 | 11 |
| Lung perfusion imaging CPT 78580 | $624.90 | $4,166.00 | $37.25 – $761.23 | 24 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $6,750.00 | $45,000.00 | $43.51 – $116.44 | 17 |
| Lymphatics/lymph node imaging CPT 78195 | $937.05 | $6,247.00 | $58.85 – $1,010.34 | 24 |
| Lymphocyte transformation mitogen CPT 86353 | $23.55 | $157.00 | $49.03 – $566.24 | 13 |
| Macroscopic exam arthropod CPT 87168 | $20.57 | $137.10 | $0.30 – $49.31 | 13 |
| Macroscopic exam parasite CPT 87169 | $2.25 | $15.00 | $0.34 – $49.31 | 13 |
| Magnesium CPT 83735 | $42.15 | $281.00 | $0.33 – $76.91 | 13 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $19.84 | $132.26 | $0.86 – $41.15 | 10 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $94.80 | $632.00 | $16.78 – $447.00 | 14 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $123.60 | $824.00 | $28.54 – $447.00 | 14 |
| Mapping io sentinel lymph node CPT 38900 | $72.90 | $486.00 | $50.00 – $359.16 | 19 |
| Map tachycard site(s) CPT 93609 | $1,946.10 | $12,974.00 | $12,974.00 – $12,974.00 | 1 |
| Marker biop eviva buckle ss HCPCS A4648 | $713.70 | $4,758.00 | $541.00 – $541.00 | 1 |
| Mastectomy partial CPT 19301 | $368.10 | $2,454.00 | $66.64 – $973.70 | 19 |
| Mast mod rad CPT 19307 | $657.15 | $4,381.00 | $70.00 – $2,455.63 | 19 |
| Mast radical CPT 19305 | $638.25 | $4,255.00 | $870.44 – $2,348.54 | 19 |
| Mast simple complete CPT 19303 | $798.60 | $5,324.00 | $762.84 – $1,932.63 | 19 |
| Mayo aathr protein s free CPT 85306 | $2.04 | $13.62 | $2.09 – $177.08 | 13 |
| Mayo activated protein c resistance assay CPT 85307 | $2.04 | $13.62 | $2.09 – $176.92 | 13 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $31.58 | $210.50 | $38.57 – $160.55 | 13 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $14.49 | $96.59 | $0.05 – $114.63 | 6 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $108.15 | $721.00 | $0.05 – $188.09 | 6 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $2.67 | $17.80 | $1.73 – $170.86 | 13 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $42.30 | $282.00 | $0.05 – $318.46 | 6 |
| Mayo alpha 1 antitrypsin CPT 82103 | $20.10 | $134.00 | $1.60 – $155.07 | 13 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $2.01 | $13.40 | $2.02 – $174.12 | 13 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $1.29 | $8.59 | $0.05 – $181.36 | 6 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $1.29 | $8.59 | $0.05 – $164.87 | 6 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $42.00 | $280.00 | $121.63 – $1,428.93 | 13 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $29.25 | $195.00 | $91.03 – $534.90 | 13 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | $20.55 | $137.00 | $109.60 – $941.86 | 13 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $217.13 | $1,447.50 | $97.81 – $12,702.00 | 13 |
| Mayo androstenedione CPT 82157 | $4.62 | $30.80 | $9.02 – $338.06 | 13 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $1.95 | $12.98 | $1.90 – $168.60 | 13 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $2.26 | $15.05 | $1.27 – $173.89 | 13 |
| Mayo avwpr vw factor activity CPT 85397 | $73.20 | $488.00 | $17.05 – $253.06 | 13 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | $4.52 | $30.15 | $10.58 – $183.79 | 11 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $92.85 | $619.00 | $0.05 – $270.64 | 6 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $1.36 | $9.05 | $0.92 – $117.43 | 13 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $21.73 | $144.84 | $35.00 – $446.71 | 13 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | $7.65 | $51.00 | $51.00 – $1,294.31 | 13 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | $21.90 | $146.00 | $0.05 – $196.21 | 6 |
| Mayo brcmg brucella antibody igm CPT 86622 | $1.19 | $7.94 | $0.71 – $93.17 | 13 |
| Mayo c1 esterase inhibitor CPT 83883 | $1.81 | $12.09 | $1.64 – $157.25 | 13 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $7.50 | $50.00 | $0.05 – $251.27 | 6 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $2.25 | $14.99 | $2.53 – $193.96 | 13 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $6.20 | $41.33 | $3.11 – $309.29 | 13 |
| Mayo ceruloplasmin CPT 82390 | $19.20 | $128.00 | $0.90 – $124.04 | 13 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $22.17 | $147.80 | $4.41 – $163.24 | 13 |
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.