| EMERGENCY ROOM | ||
| SERVICE CHARGE CODE | SERVICE DESCRIPTION | SERVICE CHARGE PRICE |
| 900000 | DEFIBRILLATION/CARDIOVERSION | 117.53 |
| 900088 | PHYSICAL EXAM-ANNUAL | 84.89 |
| 900178 | ER-OB/GYN ROOM | 115.48 |
| 900185 | ER-SPECIALTY ROOM | 57.38 |
| 900194 | ER-TRAUMA ROOM | 999.62 |
| 900227 | EMERGENCY ROOM | 67.48 |
| 900243 | ER-OBSERVATION ROOM | 84.35 |
| 910060 | I&D ABSCESS | 26.42 |
| 931500 | INTUBATION | 4.62 |
| 932020 | THORACOSTOMY INSERTION | 64.71 |
| 936425 | VENIPUNCTURE | 38.30 |
| 936480 | CVP CATHETER INSERTION | 101.69 |
| 996000 | CODE 72 (ARREST) PCV | 104.34 |
| 1200000 | M.L. REPAIR-SIMPLE | 42.46 |
| 1201000 | SKIN, SUBQ & AREOLAR TISSUE | 63.68 |
| 1202000 | ML REPAIR-SUPERFICIAL WOUND | 84.89 |
| 1212000 | SIMPLE REPAIR-SUPERF WOUND | 84.89 |
| 1214000 | ADJ TISSUE TRANS/REARRANGM | 106.12 |
| 1220000 | GENERAL INCISION-ABSCESS | 106.12 |
| 1222000 | SPINE (VERTEBRAL COLUMN) | 159.20 |
| 1223000 | SHOULDER INCISION | 212.27 |
| 1224000 | HUMERUS UP ARM/ELBOW INCISION | 0.00 |
| 1230000 | RESP SYSTEM-NOSE INCISION | 0.00 |
| 4302047 | PLASTER CAST ENTIRE BODY | 123.61 |
| 4302120 | CAST SHORT LEG | 55.18 |
| 4302187 | CAST TORSO | 125.23 |
| 4302203 | CAST TORSO/HIPS | 123.61 |
| 4302393 | CAST ROOM | 19.28 |