Common Charges

July 1, 2007

	CPT Code	Description	Facility Charge ^*
1.	76805	Ultrasound Pregnancy	$614.00
2.	76092	Screening Mammography	$218.00
3.	71010	Radiology Chest - 1 View	$190.00
4.	71020	Radiology Chest - 2 View	$292.00
5.	73562	Radiology Knee - 3 View	$236.00
6.	76700	Ultrasound Abdomen	$829.00
7.	76830	Ultrasound Transvaginal	$265.00
8.	72170	Radiology Pelvis 1 View	$176.00
9.	72050	Radiology Spine Cervical - 4 View	$374.00
10.	72110	Radiology Spine Lumbosacral - complete	$462.00
11.	73110	Radiology Wrist - complete	$215.00
12.	73610	Radiology Ankle - complete	$276.00
13.	84443	Chem TSH (Thyroid Stimulating Hormone)	$161.00
14.	80061	Lipid Panel	$127.00
15.	81003	Urinalysis, automated	$29.00
16.	87210	KOH Prep	$52.00
17.	81001	Urinalysis	$58.00
18.	80101	Chem UA Tox Cocaine	$67.00
19.	85610	Prothrombin Time	$41.00
20.	82565	Creatinine Blood	$56.00
21.	84520	Urea Nitrogen	$56.00
22.	85025	Complete CBC	$98.00
23.	81025	Urine Pregnancy Test	$44.00
24.	80051	Electrolyte Panel	$150.00
25.	84153	PSA Total	$119.00

^* Facility component charge is rounded off to the nearest dollar.

This charge description master 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.

The information contained in this charge description master is specific to Contra Costa Health 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.