Pricing for Common Outpatient Procedures - Community Hospital of the Monterey Peninsula

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Average charges for 25 common procedures

Price estimates will be provided to patients upon request. Patients may contact the Patient Access price estimate line, (831) 625-4715.

Actual costs may vary based on individual circumstances.
Evaluation & Management Services (CPT Codes 99201-99499) Average Charge 2018 CPT Code
Emergency Room Visit, Level 2 (low to moderate severity) $1,063.00 99282
Emergency Room Visit, Level 3 (moderate severity) $1,615.00 99283
Emergency Room Visit, Level 4 (high severity without significant threat) $2,232.00 99284
Outpatient Visit, established patient, 15 minutes $621.00 99213
Laboratory & Pathology Services (CPT Codes 80047-89398) Average Charge 2018 CPT Code
Basic Metabolic Panel $63.00 80048
Complete Blood Count, automated $75.00 85027
Complete Blood Count, with differential WBC, automated $82.00 85025
Comprehensive Metabolic Panel $78.00 80053
Creatine Kinase (CK), (CPK), Total $236.00 82550
Lipid Panel $135.00 80061
Partial Thromboplastin Time $177.00 85730
Prothrombin Time $75.00 85610
Thyroid Stimulating Hormone $188.00 84443
Troponin, Quantitative $142.00 84484
Radiology Services  (CPT Codes 70010-79999) Average Charge 2018 CPT Code
CT Scan, Abdomen, with contrast $1,800.00 74160
CT Scan, Head or Brain, without contrast $2,032.00 70450
CT Scan, Pelvis, with contrast $3,115.00 72193
MRI, Brain, without contrast, followed by contrast $1,313.00 70553
Ultrasound, Abdomen, Complete $1,223.00 76700
Ultrasound, OB, 14 weeks or more, transabdominal $936.00 76805
X-Ray, Lower Back, minimum four views $553.00 72110
X-Ray, Chest, two views $443.00 71046
Medicine Services  (CPT Codes 90281-99607) Average Charge 2018 CPT Code
Inhalation Treatment, pressurized or nonpressurized $265.00 94640
Physical Therapy, Evaluation $339.00 97161-97163
Physical Therapy, Gait Training $163.00 97116
Physical Therapy, Therapeutic Exercise $163.00 97110
Surgery Services  (CPT Codes 10021-69990) Average Charge 2018 CPT Code
Injection, Anesthetic or Steroid, transforaminal epidural, lumbar $3,942.00 64483

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