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2018 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)
1528039039 390127 0 0 0 0 633294 851695 95143 0
1184620486 390130 0 0 0 0 672000 698977 48761 0
1164400131 390133 96119 30636 0 2145 517000 794576 72382 0
1255585303 390137 23063 14230 635 0 455845 700250 68672 0
1821091059 390138 0 0 0 0 791148 697476 50355 0
1508971441 390139 70978 34408 0 4335 408291 851695 82752 0
1902805245 390142 369904 212140 1506 4035 365688 851695 201524 0
1689691214 390145 0 0 360 1235 427067 778311 83747 0
1659360220 390146 0 0 0 0 566000 697476 69005 0
1912905548 390147 0 0 0 0 549750 778311 83801 0
1225417421 390150 0 0 0 0 591382 697476 67725 0
1972982882 390150 0 0 0 0 591382 697476 67725 0
1902804552 390151 0 0 0 0 640294 697476 46844 0
1215042114 390153 0 0 0 0 894406 851695 112573 0
1730173550 390156 159051 111309 1547 0 352862 851695 95680 0
1861486698 390156 159051 111309 1547 0 352862 851695 95680 0
1073598439 390157 0 0 0 35511 621777 778311 79651 0
1962401497 390160 0 0 0 0 539000 778311 79651 0
1740252964 390162 75610 51350 0 0 625314 794576 69498 0
1457408973 390163 0 0 374 0 591000 708700 61797 0
1568577724 390163 0 0 374 0 591000 708700 61797 0
1144384082 390164 429609 170349 862 7967 363586 778311 30996 237378
1821007881 390164 429609 170349 862 7967 363586 778311 30996 237378
1447317896 390168 0 0 732 0 515034 778311 15424 85503
1356334510 390173 0 0 0 0 537053 745220 21156 69056
1134297393 390174 52652 34199 731 45941 383273 851695 13106 170727
1215916002 390174 463742 229874 1399 15681 377172 851695 20440 237158
1225048838 390178 28914 1845 826 0 674040 716143 67454 0
1952465890 390178 28914 1845 826 0 674040 716143 67454 0
1356333579 390179 0 0 260 41582 430116 851695 50432 74103
1457715146 390180 112319 70954 923 9057 384000 851695 91558 0
1437182847 390183 0 0 0 0 569778 697476 70517 0
1144215039 390184 0 0 0 0 815338 778311 49617 0
1548322720 390185 18769 18809 0 15960 461393 700250 61462 0
1528061314 390189 0 0 0 0 1217656 755133 69969 0
1518256726 390192 0 0 0 0 635752 700250 58928 0
1356354567 390194 0 0 0 0 565986 781994 80567 0
1245335629 390195 146350 43945 0 21370 404312 851695 69913 0
1952399933 390197 65092 34620 353 4497 455759 794576 81248 0
1548263973 390198 157011 55037 1444 0 386206 718031 40275 0
1265449870 390199 0 0 840 0 649447 697476 61853 0
1568459436 390201 0 0 0 0 473822 970932 70517 0
1225091697 390203 0 0 0 2762 460513 851695 131670 0
1124023015 390204 0 0 0 6730 410795 851695 112875 0
1184672214 390211 0 0 359 42894 516785 716143 72954 0
1144255159 390217 0 0 803 0 613350 778311 61507 0
1821015462 390219 51991 28021 360 3160 445265 778311 63021 0
1336110287 390220 0 0 0 0 469486 851695 36697 94088
1407856099 390222 0 0 0 0 402183 851695 62172 0
1245207521 390223 232106 71719 1750 19353 450145 851695 152499 0
1083615587 390225 0 0 0 0 676859 739407 71263 0
1548423684 390225 0 0 0 0 676859 739407 71263 0
1063489342 390226 0 79589 0 4412 431688 851695 6728 235850
1073587119 390228 0 0 0 0 490321 778311 82448 0
1811992084 390231 129440 54408 0 21332 366297 851695 101179 0
1730158981 390233 0 0 0 0 731036 720463 64160 0
1164421335 390236 0 0 0 0 645768 697476 72098 0
1336314384 390236 0 0 0 0 645768 697476 72098 0
1881983039 390237 15748 15537 0 1102 537339 700250 70801 0
1568435477 390256 543218 185283 516 1423 868053 755133 64498 0
1780686931 390258 0 0 0 0 941264 851695 52104 107835
1598743585 390263 13629 2497 0 0 624901 781994 62523 0
1578560504 390265 0 0 0 0 506455 778311 79651 0
1023000296 390266 0 0 0 0 889640 716143 72409 0
1679592380 390267 51991 29760 0 0 527563 778311 79651 0
1104991801 390268 0 0 0 4552 868457 770307 74251 0
1730173154 390268 0 0 0 4552 868457 770307 74251 0
1780750620 390268 0 0 0 4552 868457 770307 74251 0
1093001653 390270 0 0 0 0 415541 700250 22460 99458
1104292960 390270 0 0 0 0 415541 700250 22460 99458
1174822068 390270 0 0 0 0 415541 700250 22460 99458
1205197894 390270 0 0 0 0 415541 700250 22460 99458
1235424672 390270 0 0 0 0 415541 700250 22460 99458
1265728810 390270 0 0 0 0 415541 700250 22460 99458
1275620585 390270 0 0 0 0 415541 700250 22460 99458
1447538640 390270 0 0 0 0 415541 700250 22460 99458
1649305129 390270 0 0 0 0 415541 700250 22460 99458
1649568403 390270 0 0 0 0 415541 700250 22460 99458
1669768214 390270 0 0 0 0 415541 700250 22460 99458
1760777106 390270 0 0 0 0 415541 700250 22460 99458
1770953994 390270 0 0 0 0 415541 700250 22460 99458
1861791865 390270 0 0 0 0 415541 700250 22460 99458
1881980803 390270 0 0 0 0 415541 700250 22460 99458
1528026671 390272 0 0 500 0 0 851695 31937 0
1467510560 390278 0 0 9140 0 0 851695 120316 0
1023033792 390290 402638 145927 1513 4863 330477 851695 138662 0
1043240351 390302 0 0 0 0 412000 851695 86741 0
1821020421 390304 0 0 294 52838 496395 851695 144299 0
1659392595 390307 0 0 0 0 403000 716143 72409 0
1780919043 390307 0 0 0 0 403000 716143 72409 0
1427097864 390314 0 0 0 0 300000 781994 78880 0
1124193511 390316 0 0 0 0 300000 729049 73695 0
1043456957 390321 0 0 0 0 284000 794576 78905 0
1336378132 390322 0 0 0 0 284000 851695 86741 0
1528398534 390323 0 0 0 0 278000 778311 79649 0
1265664544 390324 0 0 0 0 271000 851695 86741 0
1578881652 390325 0 0 0 0 271000 720463 72836 0
1962758375 390325 0 0 0 0 271000 720463 72836 0
1497050470 390326 0 0 0 0 271000 794576 78905 0
1760787576 390327 0 0 0 0 407000 720463 72836 0
1225323983 390328 0 0 0 0 268000 778311 79651 0
1104192590 390329 0 0 0 0 268000 851695 86741 0
1396194197 390330 0 0 0 0 389000 700250 70801 0
1881899284 390331 0 0 0 0 234000 851695 86741 0
999993 999993 75972 37367 433 8021 431343 755133 76262 0