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2021 Workers' Compensation Fee Schedule

Table A: Prospective Payment System

NPI or Provider # Provider # Indirect Medical Education Add-On Direct Medical Education Add-On Disproportionate Share Add-On Paramedical Education Add-On Aggregate RCC DRG Rate Capital Rate Hold Harmless Rate
Implied Decimal 6
(in percentages) 		Implied Decimal 4
(in percentages) 		Implied Decimal 6
(in percentages) 		Implied Decimal 2 (in dollars)
1750805552 390127 0 0 0 0 633294 939616 104964 0
1184620486 390130 0 0 0 0 672000 771132 53795 0
1164400131 390133 96119 30636 0 2145 517000 876599 79854 0
1255585303 390137 23063 14230 635 0 455845 772537 75761 0
1821091059 390138 0 0 0 0 791148 769476 55553 0
1508971441 390139 70978 34408 0 4335 408291 939616 91294 0
1902805245 390142 369904 212140 1506 4035 365688 939616 222327 0
1689691214 390145 0 0 360 1235 427067 858656 92392 0
1659360220 390146 0 0 0 0 566000 769476 76128 0
1912905548 390147 0 0 0 0 549750 858656 92452 0
1225417421 390150 0 0 0 0 591382 769476 74717 0
1972982882 390150 0 0 0 0 591382 769476 74717 0
1902804552 390151 0 0 0 0 640294 769476 51680 0
1215042114 390153 0 0 0 0 894406 939616 124194 0
1730173550 390156 159051 111309 1547 0 352862 939616 105557 0
1861486698 390156 159051 111309 1547 0 352862 939616 105557 0
1073598439 390157 0 0 0 35511 621777 858656 87873 0
1962401497 390160 0 0 0 0 539000 858656 87873 0
1073047981 390162 75610 51350 0 0 625314 876599 76672 0
1457408973 390163 0 0 374 0 591000 781859 68176 0
1568577724 390163 0 0 374 0 591000 781859 68176 0
1144384082 390164 429609 170349 862 7967 363586 858656 34196 261883
1821007881 390164 429609 170349 862 7967 363586 858656 34196 261883
1447317896 390168 0 0 732 0 515034 858656 17016 94330
1356334510 390173 0 0 0 0 537053 822149 23340 76184
1134297393 390174 52652 34199 731 45941 383273 939616 14459 188351
1215916002 390174 463742 229874 1399 15681 377172 939616 22550 261640
1225048838 390178 28914 1845 826 0 674040 790070 74417 0
1952465890 390178 28914 1845 826 0 674040 790070 74417 0
1356333579 390179 0 0 260 41582 430116 939616 55638 81752
1457715146 390180 112319 70954 923 9057 384000 939616 101010 0
1437182847 390183 0 0 0 0 569778 769476 77796 0
1144215039 390184 0 0 0 0 815338 858656 54739 0
1548322720 390185 18769 18809 0 15960 461393 772537 67807 0
1528061314 390189 0 0 0 0 1217656 833086 77192 0
1518256726 390192 0 0 0 0 635752 772537 65011 0
1356354567 390194 0 0 0 0 565986 862719 88884 0
1245335629 390195 146350 43945 0 21370 404312 939616 77130 0
1952399933 390197 65092 34620 353 4497 455759 876599 89636 0
1548263973 390198 157011 55037 1444 0 386206 792154 44432 0
1265449870 390199 0 0 840 0 649447 769476 68239 0
1568459436 390201 0 0 0 0 473822 1071160 77796 0
1225091697 390203 0 0 0 2762 460513 939616 145262 0
1124023015 390204 0 0 0 6730 410795 939616 124527 0
1184672214 390211 0 0 359 42894 516785 790070 80486 0
1144255159 390217 0 0 803 0 613350 858656 67857 0
1821015462 390219 51991 28021 360 3160 445265 858656 69527 0
1760906549 390220 0 0 0 0 469486 939616 40485 103801
1407856099 390222 0 0 0 0 402183 939616 68590 0
1245207521 390223 232106 71719 1750 19353 450145 939616 168241 0
1083615587 390225 0 0 0 0 676859 815736 78619 0
1548423684 390225 0 0 0 0 676859 815736 78619 0
1063489342 390226 0 79589 0 4412 431688 939616 7422 260198
1073587119 390228 0 0 0 0 490321 858656 90959 0
1811992084 390231 129440 54408 0 21332 366297 939616 111624 0
1730158981 390233 0 0 0 0 731036 794837 70784 0
1164421335 390236 0 0 0 0 645768 769476 79540 0
1336314384 390236 0 0 0 0 645768 769476 79540 0
1881983039 390237 15748 15537 0 1102 537339 772537 78109 0
1568435477 390256 543218 185283 516 1423 868053 833086 71155 0
1780686931 390258 0 0 0 0 941264 939616 57482 118967
1578560504 390265 0 0 0 0 506455 858656 87873 0
1023000296 390266 0 0 0 0 889640 790070 79883 0
1679592380 390267 51991 29760 0 0 527563 858656 87873 0
1104991801 390268 0 0 0 4552 868457 849826 81916 0
1730173154 390268 0 0 0 4552 868457 849826 81916 0
1780750620 390268 0 0 0 4552 868457 849826 81916 0
1093001653 390270 0 0 0 0 415541 772537 24779 109725
1104292960 390270 0 0 0 0 415541 772537 24779 109725
1174822068 390270 0 0 0 0 415541 772537 24779 109725
1205197894 390270 0 0 0 0 415541 772537 24779 109725
1235424672 390270 0 0 0 0 415541 772537 24779 109725
1265728810 390270 0 0 0 0 415541 772537 24779 109725
1275620585 390270 0 0 0 0 415541 772537 24779 109725
1447538640 390270 0 0 0 0 415541 772537 24779 109725
1649305129 390270 0 0 0 0 415541 772537 24779 109725
1649568403 390270 0 0 0 0 415541 772537 24779 109725
1669768214 390270 0 0 0 0 415541 772537 24779 109725
1760777106 390270 0 0 0 0 415541 772537 24779 109725
1770953994 390270 0 0 0 0 415541 772537 24779 109725
1861791865 390270 0 0 0 0 415541 772537 24779 109725
1881980803 390270 0 0 0 0 415541 772537 24779 109725
1528026671 390272 0 0 500 0 0 939616 35235 0
1467510560 390278 0 0 9140 0 0 939616 132736 0
1083986129 390304 0 0 294 52838 496395 939616 159195 0
1659392595 390307 0 0 0 0 403000 790070 79883 0
1780919043 390307 0 0 0 0 403000 790070 79883 0
1225678881 390314 0 0 0 0 300000 862719 87023 0
1124193511 390316 0 0 0 0 300000 804308 81302 0
1033759626 390321 0 0 0 0 284000 876599 87050 0
1336378132 390322 0 0 0 0 284000 939616 95695 0
1528398534 390323 0 0 0 0 278000 858656 87871 0
1265664544 390324 0 0 0 0 271000 939616 95695 0
1578881652 390325 0 0 0 0 271000 794837 80355 0
1962758375 390325 0 0 0 0 271000 794837 80355 0
1497050470 390326 0 0 0 0 271000 876599 87050 0
1760787576 390327 0 0 0 0 407000 794837 80355 0
1225323983 390328 0 0 0 0 268000 858656 87873 0
1104192590 390329 0 0 0 0 268000 939616 95695 0
1396194197 390330 0 0 0 0 389000 772537 78109 0
1881899284 390331 0 0 0 0 234000 939616 95695 0
1265096069 390332 0 0 0 0 344000 769476 79540 0
1215598156 390333 0 0 0 0 326000 858656 87873 0
1285295899 390333 0 0 0 0 326000 858656 87873 0
1578124418 390333 0 0 0 0 326000 858656 87873 0
1699215374 390333 0 0 0 0 326000 858656 87873 0
999993 999993 75972 37367 433 8021 431343 833086 84135 0