Common Outpatient Charges
As of July 1, 2013
|Evaluation & Management Services||CPT Code||Facility Charge|
|Emergency Room Visit, Level 2
(low to moderate severity)
|Emergency Room Visit, Level 3
|Emergency Room Visit, Level 4
|Outpatient Visit, established patient, 15 minutes||99213||$55.00|
|Laboratory & Pathology Services|
|Basic Metabolic Panel||80048||$164.00|
|Blood Gas Analysis, including 0₂ saturation||82805||$354.00|
|Complete Blood Count, automated||85027||$76.00|
|Complete Blood Count, with differential WBC, automated||85025||$104.00|
|Comprehensive Metabolic Panel||80053||$251.00|
|Creatine Kinase (CK), (CPK), Total||82550||$83.00|
|Partial Thromboplastin Time||85730||$59.00|
|Thyroid Stimulating Hormone||84443||$171.00|
|Urinalysis, without microscopy||81003||$31.00|
|Urinalysis, with microscopy||81001||$61.00|
|CT Scan, Abdomen, with contrast||74160||$1,206.00|
|CT Scan, Head or Brain, without contrast||70450||$751.00|
|CT Scan, Pelvis, with contrast||72193||$1,109.00|
|Mammography, Screening, Bilateral||77057||$230.00|
|MRI, Head or Brain, without contrast, followed by contrast||70553||$2,862.00|
|Ultrasound, Abdomen, Complete||76700||$879.80|
|Ultrasound, OB, 14 weeks or more, transabdominal||76805||$651.00|
|X-Ray, Lower Back, four views||72110||$490.00|
|X-Ray, Chest, two views||71020||$309.00|
Payers' Bill of Rights
The Hospital's Charge Description Master, representing a list of charges that could appear on your hospital or outpatient bill, is available for your inspection based on Chapter 2 of Division 2, commencing with Section 1339.50 of the California Health and Safety Code. Phone 925-957-7400 to schedule an appointment.
A list of 25 commonly charged items will be provided upon request, and is available on our website at www.cchealth.org, or at the Admissions Office, Emergency Department, or the Patient Accounting Department.
Office of Statewide Hospital Planning and Development (OSHPD) hospital outcome studies are available for inspection in the Quality Management Department. To schedule an appointment to review reports please contact Administration at 370-5100.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) hospital survey information is available on the JCAHO website at www.jointcommission.org.