| SIERRA KINGS DISTRICT HOSPITAL REEDLEY CA | ||||||
| 25 COMMON PROCEDURES/SERVICES - AB 1627 CHARGEMASTER FOR OSHPD | ||||||
| Jul-06 | ||||||
| DEPT | PCU | DESCRIPTION | Charge | CPT | ||
| Radiology | 32400030 | Chest 2 Views | 178.40 | 71022 | ||
| 32000470 | Knee, 3 views | 91.85 | 73562 | |||
| MRI | 61100000 | Brain w/o contrast | 2683.15 | 70551 | ||
| 61200040 | Lumbar Spine w/o contrast | 3897.30 | ||||
| CT | 35100000 | CT Head w/o contrast | 884.75 | 70450 | ||
| 35200110 | CT Pelvis w/o contrast | 919.95 | ||||
| Ultrasound | 40200050 | OB US Fetal Age | 394.26 | 76805 | ||
| 40200010 | Abdominal US | 450.06 | ||||
| Mammography | 40300000 | Mamm, Bilateral | 136.40 | 76092 | ||
| 40102420 | Mamm, Unilateral | 96.45 | ||||
| Lab | 30000310 | Basic Metabolic Panel | 42.84 | 80048 | ||
| 30500500 | Complete CBC | 45.10 | 85025 | |||
| 30500080 | Prothrombin Time | 21.18 | 85610 | |||
| ER | 45000620 | Conscious Sedation | 126.40 | |||
| 45000520 | ER Room - level III | 295.00 | 99283 | |||
| RHC | 98340150 | Office Visit Limited | 90.00 | 99213 | ||
| 52140080 | OP Clinic Visit - est | 45.00 | 99214 | |||
| L&D | 72000050 | Labor Epidural | 487.05 | |||
| 72000110 | OB Check | 125.25 | 99218 | |||
| Surg | 36000050 | OR Level II, Initial Hour | 1500.00 | |||
| Recovery | 71000000 | Recovery Rm/Hr | 280.86 | |||
| Endoscopy | 49000016 | Colonoscopy w/Polypectomy | 605.95 | |||
| Path Lab | 39000080 | Crossmatch,Antiglobulin | 75.90 | 86921 | ||
| EKG | 73000000 | EKG | 116.88 | 93005 | ||
| Blood Bank | 39000055 | Antibody Screen | 35.00 | J7619 | ||
| RT | 41000130 | HH Neb-Initial | 105.25 | J2912 | ||