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Contra Costa Health Services

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					Contra Costa Health Services Common Test, Procedure, and Room Charges As of April 1, 2005
CPT Code 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Facility Charge * $5,800.00 2,100.00 1,400.00 1,900.00 173.00 265.00 215.00 753.00 241.00 160.00 340.00 420.00 195.00 251.00 146.50 115.50 26.50 47.50 53.00 60.50 37.50 50.50 50.50 89.00 39.50

Description Intensive Care Day (room charge) Medical / Surgical Day (room charge) Well Baby Nursery Day (room charge) Psychiatric Acute Day (room charge) Radiology Chest - 1 View Radiology Chest - 2 View Radiology Knee – 3 View Ultrasound Abdomen Ultrasound Transvaginal Radiology Pelvis 1 View Radiology Spine Cervical – 4 View Radiology Spine Lumbosacral–complete Radiology Wrist – complete Radiology Ankle – complete Chem TSH (Thyroid Stimulating Hormone) Lipid Panel Urinalysis, automated KOH Prep Urinalysis Chem UA Tox Cocaine Prothrombin Time Creatinine Blood Urea Nitrogen Complete CBC Urine Pregnancy Test

71010 71020 73562 76700 76830 72170 72050 72110 73110 73610 84443 80061 81003 87210 81001 80101 85610 82565 84520 85025 81025

* 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.


				
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