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Common Outpatient Charges

As of July 1, 2013

Evaluation & Management Services CPT Code Facility Charge
Emergency Room Visit, Level 2
(low to moderate severity)
99282 $160.00
Emergency Room Visit, Level 3
(moderate severity)
99283 $230.00
Emergency Room Visit, Level 4
(high severity)
99284 $630.00
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
Lipid Panel 80061 $135.00
Partial Thromboplastin Time 85730 $59.00
Prothrombin Time 85610 $48.00
Thyroid Stimulating Hormone 84443 $171.00
Troponin, Quantitative 84484 $103.00
Urinalysis, without microscopy 81003 $31.00
Urinalysis, with microscopy 81001 $61.00
Radiology Services    
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

The charge information in this document is made available for your inspection based on Chapter 2 of Division 2, commencing with Section 1339.50 of the California Health and Safety Code, also known as the Payers Bill of Rights.

The charge information contained in this document is specific to Contra Costa Health Services and does not include fees for professional services. Descriptions and charges contained in this document will vary from facility to facility.

The physician orders, based on his/her examination and treatment of the patient, are the key components in determining which services and procedures are charged to an individual patient. There are many components that comprise a hospital bill. For example, a short hospital inpatient stay could include surgical procedures, treatment in the emergency department, supplies, pharmaceuticals, room and board, numerous tests (i.e., x-rays, laboratory), and respiratory and physical therapy (all based on a physician's orders). Therefore, this document should not be used to accurately estimate the final patient cost of a given hospital stay or outpatient visit. It is provided for information only.

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, 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