Outpatient Standard Charges Report
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CPT PRICES BY HOSPITAL
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CPTDescriptionCOMPARATOR GROUP AVGJohn Muir Medical Center-Walnut CreekAlta Bates Summit Med Ctr-Alta BatesAlta Bates Summit Med Ctr-SummitCalifornia Pacific Med Ctr-PacificEden Medical CenterNorthBay Medical CenterSan Ramon Regional Medical CenterStanford HospitalStanford ValleyCare-LivermoreSutter Delta Medical CenterUC Davis Medical CenterUCSF Medical Center
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00140Anesthesia for procedure on eye$5,732.00N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$5,732.00
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00142Anesthesia for lens surgery$3,620.00N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$3,620.00
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00320Anesthesia for procedure on esophagus and neck, age 1 year or older$9,428.00N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$9,428.00
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0042T
Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast
$7,438.79$8,505.00N/AN/A$7,201.00$6,742.00N/A$1,027.35N/AN/AN/AN/AN/A
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00520Anesthesia for closed procedure in chest$2,608.00N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$2,608.00
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00732
Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP)
$3,356.00N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$3,356.00
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0159T
Computer-aided detection and computer algorithm analysis of breast MRI image data
$1,595.49N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$1,595.49N/A
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01810
Anesthesia for procedure on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand
$1,552.00N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$1,552.00
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0184TRemoval of rectal tumor using an endoscope$39,253.00N/AN/AN/AN/AN/AN/AN/A$39,253.00N/AN/AN/AN/A
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01916Anesthesia for diagnostic X-ray procedure on arteries or veins$3,400.00N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$3,400.00
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0191TInternal insertion of eye fluid drainage device$8,959.38N/A$4,251.50N/AN/AN/AN/A$7,353.54$26,308.00$6,755.99N/A$9,298.24$6,811.34
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0216TInjections of lower or sacral spine joint or nerves using ultrasound guidance$12,628.00N/AN/AN/AN/AN/AN/AN/A$12,628.00N/AN/AN/AN/A
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0232TInjection(s), platelet rich plasma$9,935.56N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$9,935.56N/A
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0275T
Removal of lower spine bone for decompression of neural elements using imaging guidance, accessed through the skin
$37,029.99N/AN/AN/AN/AN/AN/AN/A$37,029.99N/AN/AN/AN/A
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0296TExternal EKG recording for more than 48 hours up to 21 days$831.92$475.50N/AN/AN/AN/AN/AN/A$948.00N/AN/A$1,029.12$742.00
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0297T
Analysis and report of external EKG recording for more than 48 hours up to 21 days
$528.95N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$4,511.97$347.00
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0346TUltrasound Elastography$557.62N/AN/A$480.00N/AN/AN/AN/AN/AN/AN/A$603.26N/A
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0387T
Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular
$39,241.00N/AN/A$39,241.00N/AN/AN/AN/AN/AN/AN/AN/AN/A
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0398T
Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when performed
$42,194.00N/AN/AN/AN/AN/AN/AN/A$42,194.00N/AN/AN/AN/A
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0466T
Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (List separately in addition to code for primary procedure)
$29,334.50N/AN/AN/AN/AN/AN/AN/A$29,334.50N/AN/AN/AN/A
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0474T
Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space
$8,587.88N/AN/AN/A$2,802.50N/AN/AN/A$26,307.99N/AN/AN/A$7,084.67
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10021Fine needle aspiration$712.18N/AN/A$610.00$2,595.00N/AN/AN/A$967.00N/AN/A$485.00$692.00
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10022Fine needle aspiration using imaging guidance$1,486.99$819.50$1,544.00$1,544.00$1,544.00$1,544.00N/A$1,866.97$3,230.00$1,867.00$1,544.00$907.60$628.00
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10030
Fluid collection drainage by catheter using imaging guidance, accessed through the skin
$2,704.79N/AN/AN/A$2,075.00N/AN/AN/A$4,429.00N/AN/A$1,508.15$1,506.00
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10035
Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion
$1,719.00N/AN/AN/A$1,719.00N/AN/AN/AN/AN/AN/AN/AN/A
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10040Acne surgery$287.07N/AN/AN/AN/AN/AN/AN/A$336.00N/AN/A$278.85$167.00
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10060Drainage of Abscess$872.04$1,105.25$610.00$610.00$610.00$610.00$1,356.00$89.80$1,451.00$1,442.50$590.00$1,133.83$276.00
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10061Drainage of multiple abscess$1,361.98$1,407.25$610.00$1,005.00$10,198.00N/A$1,356.00N/A$443.00$1,658.00$590.00$1,432.20$1,672.00
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10080Drainage of tailbone cyst$610.00N/AN/AN/AN/A$610.00N/AN/AN/AN/AN/AN/AN/A
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10120Removal of foreign body from tissue, accessed beneath the skin$2,634.86N/A$1,469.00$986.00N/A$610.00N/AN/A$8,654.00N/AN/A$473.06$535.00
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10140Drainage of blood or fluid accumulation$7,013.10$25,314.00N/AN/A$2,039.60N/AN/A$1,225.83$4,293.00$10,134.34N/A$5,530.25$2,410.00
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10160Aspiration of abscess, blood accumulation, blister, or cyst$609.16$1,184.50$1,469.00$717.00$687.00N/AN/A$269.38$443.00N/A$1,424.00$894.04$276.00
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10180Drainage of wound infection after surgery$45,725.00N/AN/AN/AN/AN/AN/AN/A$45,725.00N/AN/AN/AN/A
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11000Removal of inflamed or infected skin, up to 10% of body surface$987.35N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$987.35N/A
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11005Removal of infected skin, tissue or muscle of abdomen$18,342.00$18,342.00N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
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11011
Removal of foreign material from skin, tissue, and muscle at open fracture and/or dislocation
$10,970.50N/AN/AN/AN/A$10,970.50N/AN/AN/AN/AN/AN/AN/A
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11012
Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation
$1,174.00$1,174.00N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
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11042Removal of skin and tissue first 20 sq cm or less$1,737.93$2,424.00$8,503.00$11,957.00N/AN/A$520.33$664.31$960.00N/A$1,818.00$1,433.83$535.00
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11043Removal of skin and/or muscle first 20 sq cm or less$2,453.39$2,550.00N/AN/AN/A$8,704.50$61,928.62$2,143.61$1,259.00N/A$3,106.00$3,099.74$11,201.00
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11044Removal of skin and bone first 20 sq cm or less$3,715.87$5,068.00N/AN/AN/AN/AN/AN/A$3,007.00N/A$4,428.00$12,618.97$17,203.52
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11045Removal of skin and tissue$1,232.60$2,392.50N/A$5,115.00N/AN/A$289.69$1,328.62$416.00N/A$1,072.00N/AN/A
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11046Removal of skin and/or muscle$1,557.68$5,037.00N/AN/AN/AN/A$291.41N/A$438.00N/AN/A$3,099.74$3,060.33
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11047Removal of skin and bone$1,273.08N/AN/AN/AN/AN/AN/AN/A$1,241.00N/A$2,257.00N/AN/A
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11055Removal of single thickened skin growth$241.49$387.75N/AN/AN/AN/AN/A$664.31$314.00N/A$287.00$247.92$167.00
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11056Removal of 2 to 4 thickened skin growths$271.79N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$271.79N/A
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11057Removal of more than 4 thickened skin growths$329.30N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$329.30N/A
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11100Biopsy of single growth of skin and/or tissue$614.20$899.00$9,432.50N/AN/AN/A$67,174.96N/A$678.00$3,507.50N/A$791.51$295.00
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11101Biopsy of each additional growth of skin and/or tissue$259.17N/AN/AN/AN/AN/AN/AN/A$194.00N/AN/A$436.71$167.00
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11200Removal of up to and including 15 skin tags$861.38N/AN/AN/AN/AN/A$1,356.00$7,353.54$232.00N/AN/A$1,021.53$167.00
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11300Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs$482.71N/AN/AN/AN/AN/AN/AN/A$386.00N/AN/A$487.17N/A
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11301
Shaving of 0.6 centimeters to 1.0 centimeters skin growth of the trunk, arms, or legs
$729.12N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$729.12N/A
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11302Shaving of 1.1 to 2.0 centimeters skin growth of the trunk, arms, or legs$801.82N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$801.82N/A
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11303Shaving of over 2.0 centimeters skin growth of the trunk, arms, or legs$881.56N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$881.56N/A
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11305
Shaving of 0.5 centimeters or less skin growth of scalp, neck, hands, feet, or genitals
$226.77N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$226.77N/A
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11306
Shaving of 0.6 centimeters to 1.0 centimeters skin growth of scalp, neck, hands, feet, or genitals
$226.77N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$226.77N/A
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11307
Shaving of 1.1 to 2.0 centimeters skin growth of scalp, neck, hands, feet, or genitals
$329.30N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$329.30N/A
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11310
Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth
$699.83N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$699.83N/A
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11312
Shaving of 1.1 to 2.0 centimeters skin growth of face, ears, eyelids, nose, lips, or mouth
$1,168.00N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$1,168.00N/A
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11400Removal of growth (0.5 centimeters or less) of the trunk, arms or legs$1,958.49N/AN/AN/AN/AN/AN/AN/A$1,361.67N/AN/A$2,096.22N/A
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11401Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs$2,007.37N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$2,727.15$833.00
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11402Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs$1,705.22N/AN/A$3,985.68N/AN/AN/AN/A$963.00$2,393.25N/A$2,990.80$833.00
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11403Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs$2,741.50N/AN/AN/AN/AN/AN/AN/A$2,485.00$3,632.25N/A$3,859.35$1,567.00
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11404Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs$3,814.40N/A$3,388.00$3,985.66N/AN/AN/AN/AN/AN/AN/A$4,245.06$3,341.00
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11406Removal of growth (4.0 centimeters) of the trunk, arms, or legs$13,732.19N/AN/A$6,842.00N/AN/A$59,500.73$12,212.35$5,111.00N/AN/AN/AN/A
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11420
Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals
$8,719.91N/AN/AN/AN/AN/AN/AN/A$1,873.00$1,791.00N/A$9,638.30N/A
70
11421
Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals
$2,591.17N/AN/AN/AN/AN/AN/AN/A$1,630.00N/AN/A$4,669.30$1,567.00
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11422
Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals
$3,754.25$20,241.00N/AN/AN/AN/AN/AN/A$1,873.00N/AN/A$5,741.28$1,567.00
72
11423
Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals
$4,502.21N/AN/AN/AN/AN/AN/AN/A$2,552.00N/AN/A$9,638.30$3,341.00
73
11424
Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals
$7,980.87N/AN/AN/AN/AN/AN/A$9,481.11$2,552.00N/AN/A$7,546.18$15,629.00
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11426
Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals
$4,751.50N/AN/AN/A$5,605.00N/AN/AN/AN/AN/AN/AN/A$4,467.00
75
11440
Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth
$1,572.93N/AN/AN/AN/AN/AN/AN/A$817.00N/AN/A$2,021.36$833.00
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11441
Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth
$1,442.56N/AN/AN/AN/AN/AN/AN/A$960.00N/AN/A$2,582.30$833.00
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11442
Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth
$2,387.30N/AN/AN/AN/AN/AN/AN/A$2,485.00N/AN/A$2,872.54$1,567.00
78
11443
Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth
$2,880.27N/AN/AN/AN/AN/AN/AN/A$2,485.00N/AN/A$3,512.69N/A
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11446
Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth
$6,372.21N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$6,372.21N/A
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11462Removal of skin and tissue beneath the skin of groin for excessive sweating$3,207.00N/AN/A$3,207.00N/AN/AN/AN/AN/AN/AN/AN/AN/A
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11463Removal of skin and tissue beneath the skin of groin for excessive sweating$12,243.34N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$12,243.34
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11470
Removal of skin and tissue beneath the skin of anus or navel for excessive sweating
$3,207.00N/AN/A$3,207.00N/AN/AN/AN/AN/AN/AN/AN/AN/A
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11600
Removal of malignant growth (0.5 centimeters or less) of the trunk, arms, or legs
$6,334.65N/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$3,104.19$8,757.50
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11601
Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs
$2,538.93N/AN/AN/AN/AN/AN/AN/A$1,408.00N/AN/A$3,861.52$833.00
85
11602
Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs
$1,790.00N/AN/AN/A$5,440.68$13,614.00N/AN/A$1,408.00$1,688.90N/A$4,243.98$833.00
86
11603
Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs
$2,606.84N/AN/A$3,207.00$5,864.50N/AN/AN/A$1,635.00N/AN/A$5,044.71$1,567.00
87
11604
Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs
$11,184.03N/AN/AN/AN/AN/AN/A$1,109.50$29,543.99N/AN/A$5,566.59$1,567.00
88
11606
Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs
$18,617.48N/A$1,262.25N/A$2,039.60N/AN/AN/A$40,833.97N/A$3,524.00$9,299.22$9,357.52
89
11620
Removal of malignant growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals
$5,530.39N/AN/AN/A$1,427.20N/AN/AN/A$1,873.00N/AN/A$9,299.22N/A
90
11621
Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals
$8,943.34N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A$8,943.34
91
11622
Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals
$2,105.35N/AN/AN/AN/AN/AN/AN/A$2,036.00N/AN/A$2,775.43$1,567.00
92
11623
Removal of malignant growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals
$2,771.42N/AN/AN/AN/AN/AN/AN/A$2,552.00N/AN/A$3,429.69N/A
93
11624
Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals
$3,378.90N/AN/AN/AN/AN/AN/AN/A$2,552.00N/A$6,686.50N/AN/A
94
11626
Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals
$13,419.33N/AN/AN/A$8,926.50N/AN/AN/AN/AN/AN/AN/A$14,355.34
95
11640
Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips
$1,623.25N/AN/AN/A$2,378.68N/AN/AN/AN/AN/AN/A$1,371.44N/A
96
11641
Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips
$1,777.00N/AN/AN/AN/AN/AN/AN/A$1,777.00N/AN/AN/AN/A
97
11642
Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips
$1,957.51N/A$7,984.00N/AN/AN/AN/AN/AN/A$2,222.70N/A$1,852.64$1,567.00
98
11643
Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips
$2,552.00N/AN/AN/AN/AN/AN/AN/A$2,552.00N/AN/AN/AN/A
99
11644
Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips
$68,376.00N/AN/AN/AN/AN/AN/AN/A$68,376.00N/AN/AN/AN/A
100
11646
Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips
$20,856.24N/AN/AN/AN/AN/AN/AN/A$44,204.99$2,222.66N/A$14,024.53$14,153.00
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