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Fee Schedule
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Fee Schedule C Part II
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)
1134135577
395422
30341
100
1396148726
395425
47942
100
1255345302
395426
39445
70
1265435952
395427
49158
84
1669496287
395428
37926
60
1568401800
395429
50069
100
1205822418
395430
65538
60
1609875962
395431
59171
55
1659373298
395432
60079
82
1841241171
395433
15360
100
1134662489
395434
18206
80
1205810579
395435
56442
100
1326046699
395437
34284
80
1235243742
395438
58258
94
1831192228
395439
57647
100
1336194224
395440
42482
100
1770530354
395442
50069
100
1750432019
395445
49760
59
1003810524
395446
57647
70
1093701047
395448
33677
44
1275588626
395449
54010
63
1013961952
395451
47031
100
1720400443
395454
39906
100
1154372522
395456
47609
71
1639241797
395458
47609
71
1255513651
395459
57647
91
1316063324
395460
51278
81
1710095955
395461
41569
100
1720089261
395462
67968
71
1578880837
395464
40659
80
1043215072
395465
48547
80
1669411385
395466
33072
100
1134123730
395467
47490
46
1285690792
395468
34284
100
1598254997
395469
40957
100
1962936906
395471
34892
80
1851330195
395472
45511
100
1831180173
395473
45511
75
1508865627
395474
38838
100
1841286135
395475
39139
80
1588668214
395476
34284
80
1710933429
395477
50069
100
1831258045
395478
43085
100
1285621722
395479
43844
92
1598765489
395480
50671
80
1639351943
395481
40054
98
1194776427
395482
47609
71
1578500922
395483
34284
100
1427315357
395484
41868
100
1558303982
395485
50825
80
1104840750
395489
38838
95
1508808932
395490
35805
71
1922164466
395491
57955
78
1174565824
395492
40659
80
1831498567
395493
52798
100
1053802058
395494
63414
73
1700828001
395495
57802
83
1598707119
395496
53397
83
1437154648
395497
36414
100
1457851768
395499
45516
75
1194813469
395500
54616
40
1467449322
395501
43690
58
1841202504
395502
39445
100
1487642658
395506
40357
80
1083707178
395507
79799
68
1538676036
395509
93153
83
1265504369
395510
40054
100
1952340283
395512
36414
100
1235105834
395514
50368
75
1871592816
395515
86780
69
1861492258
395518
37926
89
1891205332
395519
85862
70
1427045541
395520
46120
100
1922508225
395521
68963
71
1285095869
395524
25492
100
1720041874
395525
74338
75
1487822557
395526
51583
100
1740235613
395527
48547
100
1710971932
395530
62190
71
1669466991
395533
51993
71
1023018504
395534
29203
100
1225036544
395535
41266
100
1346356805
395536
69177
65
1740328269
395537
57347
42
1770008732
395538
55602
71
1578566725
395539
41868
96
1700831013
395540
48547
100
1689621484
395541
47031
100
1487970687
395542
29125
88
1922280239
395545
37470
80
1699750745
395549
35805
80
1487655809
395550
47331
81
1730103417
395552
34587
80
1770745598
395554
56738
86
1134164031
395555
75862
60
1497757710
395556
37621
75
1225023443
395557
41721
100
1770558512
395559
33983
100
1740261221
395560
48547
90
1023016037
395561
45511
38
1659377034
395562
63414
90
1962433797
395563
32770
100
1164907846
395564
38534
100
1104240811
395566
63716
80
1942423454
395567
29203
100
1861486003
395568
44602
80
1407952765
395570
38534
100
1598787590
395571
44299
47
1659385797
395572
42176
80
1821357799
395574
54917
95
1730177080
395575
39750
45
1487177473
395577
50069
100
1013914589
395581
40957
100
1700393204
395582
34284
100
1295718039
395583
40054
100
1043213986
395585
67360
53
1407885569
395586
77374
69
1134124480
395587
56132
68
1639612120
395588
51993
71
1184626491
395589
38534
75
1255329645
395590
39750
60
1447217112
395591
53397
100
1558817924
395592
47609
71
1760475289
395593
56132
100
1194271569
395594
47609
71
1619922267
395595
50825
69
1396109450
395596
51278
100
1124023148
395597
48846
100
1508867938
395599
57347
61
1992733984
395602
33983
38
1114958774
395603
70697
65
1619975927
395604
37621
56
1770571341
395605
82527
91
1518957497
395606
47031
100
1134672900
395607
47609
71
1578568135
395609
37324
80
1093261463
395610
46590
71
1649267477
395611
28547
100
1912011446
395612
71303
89
1285062091
395613
35504
100
1790902203
395614
27710
82
1255337523
395616
64328
46
1639169501
395617
59471
79
1487602983
395618
28828
92
1023004751
395619
49454
27
1548381031
395620
77374
98
1376610725
395621
59171
95
1881690295
395622
71911
65
1043217243
395623
26094
100
1972507531
395624
33677
54
1790783017
395625
33677
80
1528055712
395626
52798
70
1705332169
395627
49307
71
1063498160
395628
36414
50
1518941657
395629
40357
55
1174529069
395631
33983
88
1184612632
395632
61286
37
1609370741
395633
34587
80
1871584409
395634
66752
100
1235478470
395636
52798
84
1962530683
395637
38534
100
1811978398
395638
75862
100
1356331235
395640
48547
82
1669462537
395643
49158
100
1093135600
395644
37324
100
1639183817
395645
49454
75
1578069191
395646
47942
80
1093829582
395647
49454
89
1114920386
395648
40659
100
1053325951
395650
36414
81
1992280671
395651
73731
63
1750339255
395652
36111
90
1518964550
395653
77065
40
1851376370
395654
23058
100
1871591479
395656
40054
100
1336143023
395660
35805
80
1750837126
395661
46590
71
1558303206
395665
53099
97
1134662471
395670
47046
71
1972599926
395671
53201
71
1891792354
395672
36713
100
1386197168
395674
47046
71
1538612312
395675
47609
71
1588655815
395677
68270
67
1336149129
395678
30455
100
1700247376
395679
54917
70
1881691145
395680
61899
100
1225040751
395681
34587
100
1962400317
395682
64929
58
1366490864
395683
61597
100
1588668107
395684
54616
80
1336179043
395686
43690
72
1831207141
395687
47331
100
1881647899
395688
36414
100
1629064472
395690
64017
85
1457396202
395691
56738
60
1275995755
395695
51583
80
1396739546
395697
61286
70
1124522230
395698
40659
80
1083628085
395699
37324
81
1457375081
395700
36414
76