2014 WC FEE SCHEDULE

Table J: Out-of-State RCC

Provider #

Revenue Code

In-Patient RCC

Out-Patient RCC

Description

   

Decimal 6 (percentage of bill charges)

 

999994

124

725

0

PSYCH ROOM & BOARD

999994

128

516

0

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

0.5219

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

0.6752

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

0.5219

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)

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