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Fee Schedule
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Fee Schedule C Part III
Begin Main Content Area
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Content Editor
2024 Workers' Compensation Fee Schedule
Table C: Skilled Nursing Facilities
NPI or Provider #
Provider #
In-Patient Allowance
Out-Patient Allowance
Implied Decimal 2 (in dollars)
1659553048
395701
66752
85
1235131418
395702
45511
50
1487644225
395704
54616
100
1013921071
395705
63107
74
1902857360
395706
47609
71
1932655305
395707
47609
71
1609864859
395708
47331
100
1861492795
395710
54917
50
1932609237
395711
57107
71
1992753495
395712
15169
98
1003887415
395713
53201
71
1295753978
395715
64017
61
1972590651
395716
27307
100
1437128139
395717
47331
86
1255329918
395718
46268
72
1912905365
395719
60079
45
1487652905
395720
51278
91
1487760765
395721
59771
35
1851390421
395726
73431
72
1114937828
395728
61286
65
1447248638
395729
43994
70
1033107073
395730
31248
80
1528013349
395731
48547
100
1083718548
395732
88296
49
1487836896
395733
54616
85
1992786438
395735
48547
75
1265474910
395736
31859
85
1366443970
395738
36414
100
1720260128
395740
64017
77
1578534244
395741
97100
51
1114916780
395742
56442
40
1093761819
395743
50069
100
1518942549
395745
64626
70
1093760837
395746
47031
100
1760450779
395749
72820
55
1497731335
395751
33379
100
1669477261
395752
41569
100
1952308942
395753
47789
0
1053352666
395754
86475
48
1740280890
395756
74944
78
1801872320
395757
50671
65
1992166565
395758
29735
100
1790739795
395760
50069
100
1962444398
395762
61899
62
1790767226
395763
47641
100
1376594697
395764
54756
71
1285622456
395765
61286
87
1487697652
395767
51583
70
1114925492
395768
57043
95
1881602332
395770
34284
96
1740351584
395771
37926
80
1477531721
395772
37926
80
1376541680
395773
57043
48
1528057411
395774
48245
60
1326035973
395775
26700
80
1942283528
395778
38838
80
1043216351
395779
54010
55
1730186578
395780
44299
74
1609058007
395782
40659
85
1841245099
395783
50069
100
1659425957
395784
53704
84
1194225409
395785
37324
80
1205835642
395786
33677
80
1295722353
395787
39445
90
1487743266
395788
46421
80
1124122759
395790
46728
100
1730361049
395791
75862
60
1467459313
395793
57955
69
1740282144
395794
32160
60
1508869652
395795
48245
100
1922055029
395796
53099
100
1346243227
395797
33983
100
1578550562
395798
35193
85
1588636344
395800
54616
80
1265485734
395801
50825
43
1528059854
395802
50069
100
1417967050
395803
89812
80
1396728366
395804
59171
60
1568463818
395805
33983
80
1720083850
395806
44908
85
1184692121
395809
96789
43
1588662936
395812
85567
39
1982680633
395815
57647
90
1457355091
395816
35805
55
1770522005
395817
56132
100
1376897207
395818
44602
80
1811994460
395819
52490
100
1134103047
395821
58863
100
1275536880
395823
55833
80
1033101803
395824
30041
80
1750360285
395825
40957
90
1588603823
395826
43994
100
1598753931
395827
43085
100
1669476313
395828
60079
100
1972506954
395830
51583
80
1730361056
395831
43085
90
1497746713
395832
44908
100
1518965946
395833
39292
80
1134175102
395834
57647
100
1417967720
395838
41569
100
1801893664
395840
57647
60
1588660906
395842
45511
80
1649265414
395843
59771
56
1891810826
395844
26398
80
1982708459
395845
47331
48
1811985971
395846
41569
100
1710978226
395847
135020
50
1275530735
395848
54616
65
1649264672
395850
30647
80
1629180732
395851
82527
65
1497047310
395852
48547
80
1467456970
395853
41868
56
1548251879
395857
55527
89
1770573321
395860
76461
80
1255321436
395861
139575
35
1073500963
395864
32770
80
1770717605
395865
51583
80
1558319053
395867
20632
80
1184958308
395868
54616
70
1366442741
395870
37926
80
1659369643
395872
30951
65
1164415360
395873
74944
74
1689676991
395875
47942
75
1275590986
395876
47331
70
1396946489
395877
68270
65
1407038714
395878
50972
90
1376537431
395879
41868
48
1578561049
395880
55527
83
1528061785
395881
86174
100
1578556528
395882
78281
80
1306137088
395883
66149
80
1881670453
395889
125621
48
1861568776
395890
145945
35
1982679437
395891
64626
80
1346784022
395892
55602
71
1184791022
395894
93458
41
1306883210
395895
43994
70
1457357683
395896
49760
100
1245236488
395898
53099
100
1033107008
395899
30341
80
1821544297
395901
47609
71
1215933601
395902
53099
46
1477735793
395904
50368
100
1194145706
395905
40659
67
1407054489
395906
33072
80
1003804634
395907
57647
30
1831187079
395908
28218
80
1184672685
395909
22755
80
1376050872
395912
57107
71
1053366328
395913
78890
100
1821096801
395915
28828
80
1164416491
395916
36713
80
1437104411
395917
75862
60
1154320950
395918
27919
80
1922009679
395922
45511
80
1265499636
395923
29125
80
1114937737
395925
91633
46
1710975693
395926
104985
45
1508882002
395927
40357
80
1780129973
395930
75862
80
1891874798
395933
64929
28
1669445870
395934
121980
22
1629075163
395936
50844
94
1255513560
395939
58971
71
1700946605
395941
80105
80
1306841101
395946
188269
36
1225033392
395948
29110
80
1235198326
395951
124978
49
1558301325
395952
67945
71
1184139552
395953
55234
71
1114099215
395959
51840
71
1073572871
395964
60488
71
1396833778
395966
122597
48
1154303311
395984
68177
65
1962409060
395985
63935
71
1326023573
395987
86642
35
1679565147
395990
113630
47
1558303693
395995
115050
60
1770595415
395996
49470
71
1700870920
395998
75862
100
1083611487
396002
185827
35
1851573174
396009
67945
71
1285628404
396015
51993
71
1760664171
396017
67945
71
1649268921
396024
24871
80
1952359457
396035
55328
71
1659382455
396040
104731
80
1629076930
396048
54849
71
1235168519
396056
40357
80
1255342580
396062
51208
65
1851382014
396064
65623
65
1962404251
396065
27307
100
1184629149
396067
56782
65
1154316057
396070
75660
69
1215452271
396073
55602
71
1851398341
396074
45820
67
1023168283
396076
68571
70
1689747685
396080
55588
80
1649276742
396081
52888
80
1194716944
396089
55900
71
1437486081
396093
59604
71
1083807911
396095
54026
71
1285741900
396098
49952
80
1053380857
396100
55805
71
1922056076
396101
51208
65
1164509261
396102
61389
60
1841288214
396105
50517
71
1477591014
396108
55972
71
1588621437
396109
53642
71
1417015223
396111
63509
71
1568600849
396114
67945
71
1528377348
396126
67945
71
1750870580
396129
63780
71
1255622551
396130
54175
71
1831525179
396133
60488
60
1033530878
396134
57413
71
1790102622
396135
53642
71
1992100408
396136
74209
71
1649789884
396144
59591
71
1255846119
396145
51993
71
1588132716
396146
56751
71
999995
999995
45511
71