|
Service Code (*)
|
Service Description (*)
|
Service Price (*)
|
|
AA00000 |
ROOM & BOARD ICU
|
$1,272.84
|
|
AA00006 |
ROOM & BOARD PICU
|
$1,098.70
|
|
AA00003 |
ROOM & BOARD NICU
|
$825.29
|
|
AA00011 |
ROOM & BOARD MEDICAL PRIVATE
|
$587.94
|
|
AA00012 |
ROOM & BOARD MEDICAL
SEMI-PRIVATE |
$537.94
|
|
AA24012 |
OBSERVATION BED/HOUR MEDICAL
|
$22.41
|
|
AA00020 |
ROOM & BOARD SURGICAL
PRIVATE |
$573.21
|
|
AA00021 |
ROOM & BOARD SURGICAL
SEMI-PRIVATE |
$523.21
|
|
AA24021 |
OBSERVATION BED/HOUR
SURGICAL |
$21.80
|
|
AA00008 |
ROOM & BOARD MED/SURG
PRIVATE |
$544.82
|
|
AA00009 |
ROOM & BOARD MED/SURG
SEMI-PRIVATE |
$494.82
|
|
AA24009 |
OBSERVATION BED/HOUR MED/SURG
|
$20.62
|
|
AA00004 |
ROOM & BOARD TELEMETRY
|
$714.94
|
|
AA00014 |
ROOM & BOARD PEDS PRIVATE
|
$732.19
|
|
AA00015 |
ROOM & BOARD PEDS
SEMI-PRIVATE |
$682.19
|
|
AA24015 |
OBSERVATION BED/HOUR PEDS
|
$28.42
|
|
MD90780 |
IV INFUSION THERAPY, 1 HOUR
|
$121.14
|
|
MD90781 |
IV INFUSION, ADDITIONAL HOUR
|
$84.69
|
|
MD90782 |
INJECTION, SC/IM
|
$19.30
|
|
MD90783 |
INJECTION, IA |
$42.88
|