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Fee Schedule
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Fee Schedule F
Begin Main Content Area
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Content Editor
2024 Workers' Compensation Fee Schedule
Table F: Ambulatory Surgical Centers Providers
NPI or Provider #
Provider #
MSA #
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
Group 7
Group 8
Group 9
Implied Decimal 2 (in dollars)
1043204688
6644
39
85151
114022
130758
161076
183876
218708
254896
256242
282620
1710987318
16124
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1003935354
18426
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1184678682
18949
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1821098443
20055
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1265434740
20119
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1811932275
22566
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1568448660
23964
6680
86914
116376
133461
164401
187672
222288
260149
260586
288453
1336143718
25519
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1972508174
29856
2360
86296
115551
132518
163234
186349
221035
258310
259071
286416
1992784821
34270
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1467442657
34743
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1679658710
34751
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1558363549
37292
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1881662799
37513
9280
86436
115734
132725
163492
186638
221314
258717
259403
286866
1821093204
38065
39
85151
114022
130758
161076
183876
218708
254896
256242
282620
1043937469
391385
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1326097536
43019
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1447220082
43308
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1922071315
43555
2360
86296
115551
132518
163234
186349
221035
258310
259071
286416
1831230788
43800
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1194790592
43822
2360
86296
115551
132518
163234
186349
221035
258310
259071
286416
1427015999
43866
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1366411829
44168
39
85151
114022
130758
161076
183876
218708
254896
256242
282620
1699743393
44397
9280
86436
115734
132725
163492
186638
221314
258717
259403
286866
1790786218
45504
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1033210760
46646
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1932153459
47292
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1326047937
48691
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1972599793
48701
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1831224922
49700
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1962405894
50342
2360
86296
115551
132518
163234
186349
221035
258310
259071
286416
1245233410
50795
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1043375702
51420
2360
86296
115551
132518
163234
186349
221035
258310
259071
286416
1639176183
52996
6680
86914
116376
133461
164401
187672
222288
260149
260586
288453
1932155470
53943
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1134114119
54109
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1164419842
54164
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1376511857
54599
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1609977610
56021
8050
89209
119452
136991
168744
192632
226959
267028
266273
296080
1801883970
56497
4000
87484
117147
134348
165487
188918
223460
261876
262017
290366
1154325686
57053
6680
86914
116376
133461
164401
187672
222288
260149
260586
288453
1437148681
57101
39
85151
114022
130758
161076
183876
218708
254896
256242
282620
1063465037
58496
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1134127426
60767
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1568469328
70683
6680
86914
116376
133461
164401
187672
222288
260149
260586
288453
1881704237
70721
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1609848472
71325
6680
86914
116376
133461
164401
187672
222288
260149
260586
288453
1669465209
72495
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1336170596
74311
4000
87484
117147
134348
165487
188918
223460
261876
262017
290366
1679544290
74442
6680
86914
116376
133461
164401
187672
222288
260149
260586
288453
1366498115
74693
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1427094945
75685
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1750356085
76416
9280
86436
115734
132725
163492
186638
221314
258717
259403
286866
1447218433
77418
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1467535773
77924
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1710091517
79180
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1902899289
81112
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1912933680
81870
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1639357338
83609
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1245331628
86445
240
89858
120324
137990
169976
194038
228284
268973
267881
298236
1164490728
87407
6680
86914
116376
133461
164401
187672
222288
260149
260586
288453
1205831849
87997
6680
86914
116376
133461
164401
187672
222288
260149
260586
288453
1346214947
88887
9280
86436
115734
132725
163492
186638
221314
258717
259403
286866
1770599136
89284
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1366451106
90375
280
86885
116336
133411
164336
187610
266311
260056
304594
319443
1053356436
90768
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1942364716
91527
3680
85237
114134
130892
161229
184061
262221
255138
299782
282898
1881687614
92397
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1679595680
94116
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1215997929
94210
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1437115094
94226
4000
87484
117147
134348
165487
188918
223460
261876
262017
290366
1548223654
94828
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1972535292
95499
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1790876431
96390
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1437104718
96963
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1639158058
97081
9280
86436
115734
132725
163492
186638
221314
258717
259403
286866
1801855127
97129
280
86885
116336
133411
164336
187610
266311
260056
304594
319443
1164458824
99333
280
86885
116336
133411
164336
187610
266311
260056
304594
319443
1558328518
101110
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1346266087
101652
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1063466118
103108
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1174634778
103445
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1821036138
104901
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1083670939
105406
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1912085333
105417
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1174525661
106979
9280
86436
115734
132725
163492
186638
221314
258717
259403
286866
1598773111
107265
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1508942665
108339
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1144380593
111569
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1851406821
111848
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1851469738
112119
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1184758948
113809
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1659408300
116237
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1134269483
116787
39
85151
114022
130758
161076
183876
218708
254896
256242
282620
1033220751
117335
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1386833044
117381
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1750592531
118416
4000
87484
117147
134348
165487
188918
223460
261876
262017
290366
1366647968
120544
4000
87484
117147
134348
165487
188918
223460
261876
262017
290366
1487857322
121009
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1689860124
122558
2360
86296
115551
132518
163234
186349
221035
258310
259071
286416
1194930925
126692
9140
84489
113127
129739
159810
182437
260225
252887
297452
310642
1457524282
136589
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1518112275
147649
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1740448711
152182
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1326298423
155088
2360
86296
115551
132518
163234
186349
221035
258310
259071
286416
1528292968
158340
6680
86914
116376
133461
164401
187672
222288
260149
260586
288453
1710114293
181696
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1497087399
185173
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1871729111
189660
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1194027920
219016
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1063715951
229887
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1215227194
238472
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1568742138
242874
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1750658092
246810
240
89858
120324
137990
169976
194038
228284
268970
267881
298236
1467715953
268481
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1679542149
300417
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1710087176
300460
2360
86296
115551
132518
163234
186349
221035
258310
259071
286416
1780664185
300696
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1245203405
300858
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1811938863
301729
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1730130246
303273
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1144434309
303298
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1306958103
303535
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1265435176
303901
39
85151
114022
130758
161076
183876
218708
254896
256242
282620
1518041979
307872
3240
88367
118318
135690
167149
190809
225238
264497
264179
293273
1659463669
308187
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1578528501
308562
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1366886913
335448
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1639510175
336532
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1902140577
336657
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1649270075
337358
7560
85312
114230
130998
161368
184209
219024
255349
256615
283130
1881899284
339012
6160
92990
124513
142797
175893
200799
234647
278344
275629
308624
1124439450
377894
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1124210687
391021
2360
86296
115551
132518
163234
186349
221035
258310
259071
286416
1801892724
391025
9280
86436
115734
132725
163492
186638
221314
258717
259403
286866
1578567954
391027
6280
88969
119130
136621
168293
192119
226469
266311
265676
295280
1134125719
391028
9280
86436
115734
132725
163492
186638
221314
258717
259403
286866
1902848260
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