PROVIDENCE SANTA ROSA MEMORIAL HOSPITAL

Acute Care Hospitals

3 out of 5 (CMS)

1165 MONTGOMERY DR

SANTA ROSA, CA, 95405

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(707) 525-5300

Emergency Services: Yes

Voluntary non-profit - Private

Procedure Prices at PROVIDENCE SANTA ROSA MEMORIAL HOSPITAL

HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD

CPT 36415

$41.6

EKG Tracing

CPT 93005

$98.15

HC CBC WITH DIFF AUTO

CPT 85025

$157.3

Therapeutic Exercises

CPT 97110

$180.05

Therapeutic Activities

CPT 97530

$206.05

HC COMPREHEN METABOLIC PANEL

CPT 80053

$317.85

Diagnostic Mammogram (unilateral)

CPT 77065

$383.5

Mechanical Traction

CPT 97012

$488.15

Diagnostic Mammogram (bilateral)

CPT 77066

$495.3

Screening Mammogram (bilateral)

CPT 77067

$872.3

HC PSYCHOTH IND 60 MIN IOP PSYCH

CPT 90837

$897.65

Chest X-Ray (1 view)

CPT 71045

$945.1

Chest X-Ray (2 views)

CPT 71046

$1,086.8

Abdominal Ultrasound — Limited

CPT 76705

$1,140.1

Echocardiogram w/ Doppler

CPT 93306

$1,469.65

Abdominal Ultrasound

CPT 76700

$1,794

ER Visit — Low-Moderate Complexity

CPT 99283

$1,816.75

Thoracic Spine X-Ray

CPT 72072

$2,187.25

HC L&D TRIAGE ESTAB PATIENT LVL 3 CDM

CPT 99213

$2,329.6

HC INJ FORAMEN EPIDURAL L/S

CPT 64483

$3,017.3

ER Visit — Moderate Complexity

CPT 99284

$3,077.1

Retroperitoneal Ultrasound

CPT 76770

$3,385.2

OB Ultrasound

CPT 76805

$3,669.25

MRI Brain w/o Contrast

CPT 70551

$4,332.25

ER Visit — High Complexity

CPT 99285

$4,506.45

CT Chest

CPT 71250

$4,622.8

MRI Joint of Lower Extremity

CPT 73721

$5,051.8

MRI Brain w/ Contrast

CPT 70553

$8,528

CT Abdomen & Pelvis

CPT 74177

$10,349.95

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Prices sourced from federally mandated hospital price transparency files. Cash prices reflect self-pay discounted rates. Negotiated rates vary by insurance plan. Data may not reflect current pricing — always confirm with the hospital before scheduling.