NPI or Provider # | Prov. # | Provider Name | Rev Code 420-429 | Rev Code 430-439 | Rev Code 440-449 | Rev Code 550-559 | Rev Code 560-569 | Rev Code 910-919 | Routine Care | Continuous Care | Respite Care | General Inpt | Rev Code 820-859 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Implied Decimal 2 (in dollars) | |||||||||||||
| 1063498541 | 391656 | HOSPICE OF THE SACRED HEART | 0 | 0 | 0 | 0 | 0 | 0 | 27016 | 157684 | 28047 | 120324 | 0 |
| 1669986824 | 391670 | THREE RIVERS HOSPICE | 0 | 0 | 0 | 0 | 0 | 0 | 28286 | 165098 | 29078 | 125586 | 0 |
| 1528049160 | 391674 | GRANE HOSPICE-PITTSBURGH | 0 | 0 | 0 | 0 | 0 | 0 | 28286 | 165098 | 29078 | 125586 | 0 |
| 1972918878 | 391693 | GRANE HOSPICE-HOLLIDAYSBURG | 0 | 0 | 0 | 0 | 0 | 0 | 27372 | 159764 | 28335 | 121801 | 0 |
| 1316352214 | 391732 | GRANE HOSPICE-LEMOYNE | 0 | 0 | 0 | 0 | 0 | 0 | 28831 | 168278 | 29524 | 127846 | 0 |
| 1851706873 | 391765 | GRANE HOSPICE-KING OF PRUSSIA | 0 | 0 | 0 | 0 | 0 | 0 | 30785 | 179691 | 31119 | 135949 | 0 |
| 1962583922 | 392300 | GEISINGER MEDICAL CENTER-ESRD | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 34938 |
| 1780831198 | 392632 | FRESEBIUS MEDICAL CARE PENN HILLS | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 36717 |
| 1083677587 | 392691 | DCA OF MECHANICSBURG | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 36426 |
| 1306808472 | 392723 | DUNMORE DIALYSIS | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 34938 |
| 1265739411 | 392786 | USRC ALTOONA DIALYSIS CENTER | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 35790 |
| 1023384013 | 392791 | WESTTOWN DIALYSIS | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 38684 |
| 1811257108 | 392803 | SUBURBAN CAMPUS DIALYSIS | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 36717 |
| 1538391248 | 393518 | GEISINGER MEDICAL CENTER-ESRD | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 34938 |
| 1215922471 | 394527 | TRINDLE REHAB MEDICINE ASSOC | 27257 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 1619911914 | 396578 | MONTGOMERY COUNTY REHAB AND SPORTS THERAPY | 26822 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 1851563076 | 396582 | DR. DAVID POTOKER | 0 | 0 | 18530 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 1295992683 | 396603 | THERAPEUTIC REHAB (TRAC) | 14464 | 0 | 42422 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 1972501757 | 396616 | MAHONING PT/TWOLICK VALLEY PT | 14880 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 1235519398 | 396854 | GENESIS PROSTEP LLC D/B/A ADULT SERVICES UNLIMITED | 43082 | 40687 | 53669 | 0 | 0 | 40687 | 0 | 0 | 0 | 0 | 0 |
| 999996 | 999996 | OUT-OF-STATE PROVIDER | 27257 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
2024 Workers' Compensation Fee Schedule