| MISCELLANEOUS REVENUE | ||
| SERVICE CHARGE CODE | SERVICE DESCRIPTION | SERVICE CHARGE PRICE |
| MP98001 | MIP CO-PAYMENT-ER | 5.00 |
| MP98002 | MIP CO-PAYMENT-PHARMACY | 2.50 |
| 1600127 | MORGUE FEE PER DAY | 14.87 |
| 1997000 | X-RAY COPY-FILM&IMAGING, INIT | 25.00 |
| 1997001 | X-RAY COPY-EXTRA FILM | 5.00 |
| 3300001 | HOSP PRIVILEGES APPL FEE | 230.00 |
| 3300002 | PHYSICIAN REAPPOINT FEE | 0.00 |
| 3300003 | PT ESCORT/DAY-HI, SF, WADC | 175.00 |
| 3300004 | PT ESCORT/DAY-ALL OTHERS | 150.00 |
| 3300005 | PT ESCORT/DAY-CNMI | 125.00 |
| 3303001 | VTC FEE | 120.00 |
| 3394001 | OFF-ISLAND TRANSPORT-MINIMAL CARE | 1,241.20 |
| 3394002 | OFF-ISLAND TRANSPORT-INTERMEDIATE CARE | 2,032.76 |
| 3394003 | OFF-ISLAND TRANSPORT-CRITICAL CARE | 3,268.56 |
| 6897012 | MORGUE PROCESSING FEE | 50.00 |