Provider # | Revenue Code | In-Patient RCC | Out-Patient RCC | Description |
|---|---|---|---|---|
| Decimal 6 (percentage of bill charges | ||||
| 999994 | 124 | 725.00 | 0.00 | PSYCH ROOM & BOARD |
| 999994 | 128 | 516.00 | 0.00 | REHAB ROOM & BOARD |
| 999994 | 250 | 0.247078 | 0.231776 | PHARMACY |
| 999994 | 260 | 0.572536 | 0.538411 | IV THERAPY |
| 999994 | 270 | 0.162082 | 0.151892 | MEDICAL/SURGICAL SUPPLIES |
| 999994 | 300 | 0.443699 | 0.415832 | LABORATORY |
| 999994 | 310 | 0.443699 | 0.415832 | PATHOLOGY |
| 999994 | 320 | 0.385371 | 0.358543 | RADIOLOGY-DIAGNOSTIC |
| 999994 | 330 | 0.385371 | 0.358543 | RADIOLOGY-THERAPEUTIC |
| 999994 | 340 | 0.702075 | 0.654145 | NUCLEAR MEDICINE |
| 999994 | 350 | 0.409509 | 0.380299 | CAT SCAN |
| 999994 | 360 | 0.521900 | 0.489053 | OPERATING ROOM SERVICES |
| 999994 | 370 | 0.243852 | 0.227742 | ANESTHESIA |
| 999994 | 380 | 0.476568 | 0.447296 | WHOLE BLOOD |
| 999994 | 390 | 0.476568 | 0.447296 | BLOOD STORAGE AND PROCESSING |
| 999994 | 400 | 0.373349 | 0.347059 | OTHER IMAGING SERVICES |
| 999994 | 410 | 0.170092 | 0.159419 | RESPIRATORY SERVICES |
| 999994 | 420 | 0.707859 | 0.675200 | PHYSICAL THERAPY |
| 999994 | 430 | 0.707859 | 0.687844 | OCCUPATION THERAPY |
| 999994 | 440 | 0.442788 | 0.415734 | SPEECH THERAPY |
| 999994 | 450 | 0.707965 | 0.707965 | EMERGENCY ROOM |
| 999994 | 460 | 0.170092 | 0.159419 | PULMONARY FUNCTION |
| 999994 | 470 | 0.442788 | 0.415734 | AUDIOLOGY |
| 999994 | 480 | 0.373715 | 0.349715 | CARDIOLOGY |
| 999994 | 490 | 0.521900 | 0.489053 | AMBULATORY SURGICAL CARE |
| 999994 | 510 | 0.707965 | 0.707965 | CLINIC |
| 999994 | 520 | 0.707965 | 0.707965 | FREE-STANDING CLINIC |
| 999994 | 530 | 0.707965 | 0.707965 | OSTEOPATHIC SERVICES |
| 999994 | 540 | 0.707965 | 0.707965 | AMBULANCE |
| 999994 | 610 | 0.385371 | 0.358543 | MAGNETIC RESONANCE IMAGING (MRI) |
| 999994 | 620 | 0.385371 | 0.358543 | MEDICAL/SURGICAL SUPPLIES (RAD) |
| 999994 | 636 | 0.247078 | 0.231776 | DRUGS REQUIRING SPECIFIC ID |
| 999994 | 700 | 0.521900 | 0.489053 | CAST ROOM |
| 999994 | 710 | 0.707859 | 0.707859 | RECOVERY ROOM |
| 999994 | 730 | 0.373715 | 0.349715 | EKG/ECG |
| 999994 | 740 | 0.373715 | 0.349715 | EEG |
| 999994 | 750 | 0.521900 | 0.489053 | GATRO-INTESTINAL SERVICES |
| 999994 | 760 | 0.554176 | 0.554176 | TREATMENT OR OBSERVATION ROOM |
| 999994 | 790 | 0.242092 | 0.227815 | LITHOTRIPSY |
| 999994 | 800 | 0.707965 | 0.701785 | INPATIENT RENAL DIALYSIS |
| 999994 | 820 | 0.701785 | 0.701785 | HEMODIALYSIS |
| 999994 | 830 | 0.701785 | 0.701785 | PERITONEAL DIALYSIS |
| 999994 | 910 | 0.454186 | 0.424381 | PSYCHIATRIC/PSYCHOLOGICAL SERVICES |
| 999994 | 920 | 0.385371 | 0.358543 | OTHER DIAGNOSTIC SERVICES |
| 999994 | 940 | 0.373715 | 0.349715 | OTHER THERAPEUTIC SERVICES |
2024 WC FEE SCHEDULE