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2023 Workers' Compensation Fee Schedule

Table C: Skilled Nursing Facilities

NPI or Provider #	Provider #	In-Patient Allowance	Out-Patient Allowance
		Implied Decimal 2 (in dollars)
1306844295	395001	56599	91
1679575989	395003	50181	100
1376533109	395006	64479	100
1265474753	395010	41133	100
1295165223	395011	85776	60
1023015138	395012	32382	100
1659875789	395013	38513	80
1871916874	395015	53463	71
1154321008	395016	42302	40
1629015078	395018	72062	80
1477565216	395020	35593	80
1245238724	395023	49160	92
1558702381	395028	83733	88
1487175816	395031	54556	63
1285619601	395032	66516	70
1629074935	395034	37928	100
1215984935	395037	42302	100
1770072175	395041	49764	71
1063418150	395042	29174	70
1396166617	395044	22463	80
1447245337	395045	44058	69
1922005271	395047	46680	70
1497750053	395050	45222	100
1629063250	395052	46680	94
1346238672	395058	40258	100
1467400960	395066	62432	90
1194015784	395067	32965	100
1194064683	395075	64769	65
1477735785	395077	68852	65
1245327428	395078	62140	60
1982602447	395080	53686	91
1902806854	395090	28301	80
1649228149	395092	16920	80
1053318501	395094	28886	80
1376664839	395095	52515	77
1033115514	395101	29468	100
1285744474	395102	32095	100
1235137472	395103	33257	100
1104829571	395104	37634	80
1356323109	395105	53391	94
1225034440	395108	48143	100
1134177637	395109	39095	80
1770562688	395110	71479	100
1316002355	395117	39970	100
1003809526	395118	53973	91
1437146917	395121	42595	100
1124079587	395123	13128	100
1205062585	395124	30339	80
1376530469	395134	55141	100
1851573166	395135	28301	100
1063694370	395138	53973	75
1538119573	395142	47320	71
1477657955	395146	65059	100
1518049899	395148	39382	100
1811208077	395155	66516	24
1225017130	395156	61265	80
1710348305	395158	49599	60
1326046061	395160	41721	70
1801894712	395164	76730	88
1053746222	395166	41721	71
1124535174	395167	56492	71
1255320032	395168	54556	45
1518951763	395171	44058	64
1205841632	395172	45222	70
1760622161	395173	69145	50
1093219040	395174	45511	83
1063711786	395176	46823	83
1932150349	395177	48810	71
1508857897	395180	36762	80
1205903630	395182	48143	67
1699738732	395188	84020	95
1093766305	395193	52650	71
1528429107	395197	42887	61
1518913136	395199	37928	100
1275086050	395200	14869	100
1821261710	395202	55430	50
1134113293	395203	48286	84
1295735157	395205	50767	60
1386616068	395206	41721	80
1306340435	395208	49889	73
1396708467	395217	70019	95
1477665198	395218	34428	80
1669423992	395223	47320	71
1386826691	395224	48431	88
1386151884	395226	50842	71
1851396972	395227	68273	55
1992729305	395228	39382	80
1184869877	395231	45222	100
1710982392	395232	47846	100
1730182189	395235	46098	78
1730540428	395237	55430	100
1679028088	395241	15465	80
1750563060	395243	42887	70
1649277625	395244	36174	100
1619928074	395247	12254	100
1255323986	395248	45511	65
1780639872	395249	52715	71
1255338976	395250	47267	85
1386695617	395252	45778	71
1558312959	395256	52650	71
1992709414	395258	63605	75
1013417328	395259	62974	71
1528068012	395260	32095	100
1033529490	395261	45511	75
1295281665	395262	17506	80
1518461565	395266	53272	71
1629110754	395270	50181	82
1902857212	395273	45778	71
1326033556	395276	60392	51
1033160494	395277	52650	71
1649279142	395278	47846	75
1619951993	395282	42747	100
1053317446	395283	43181	63
1841241254	395284	52650	71
1083632202	395285	36174	58
1033619333	395286	48677	86
1992756225	395288	45778	71
1932642287	395289	64087	100
1619459351	395290	42887	66
1518919778	395292	41133	86
1942743299	395295	16045	80
1093181752	395296	61327	71
1275581779	395298	43761	65
1407832843	395300	84020	53
1538103270	395305	53973	99
1023005766	395306	31800	41
1255312138	395307	52515	100
1073518213	395308	82560	80
1679520266	395309	49599	100
1801195524	395311	61265	35
1730137233	395313	35888	75
1497837470	395316	55141	40
1750622601	395317	42887	36
1699772327	395318	51933	100
1518915792	395319	67104	95
1184619736	395321	45809	100
1477540524	395324	58059	86
1831184506	395325	43761	100
1417937624	395326	37634	55
1013912500	395328	42302	75
1548268840	395329	40698	100
1598749558	395330	46823	100
1992209027	395331	68855	86
1093973158	395332	65644	55
1992758205	395333	52224	57
1386157485	395334	61327	71
1548716913	395335	47320	71
1699773655	395336	37344	39
1780751115	395338	44346	75
1104867902	395342	87525	60
1508813460	395344	40848	100
1194200873	395345	55430	60
1851395396	395346	50471	45
1578520011	395347	56895	65
1851346704	395348	48143	100
1891806980	395349	44346	100
1265448690	395350	29174	85
1720034002	395351	43761	100
1528139078	395352	51216	71
1760479893	395353	25170	80
1871775197	395354	43909	84
1124014691	395355	54849	80
1740287499	395356	21880	80
1366446288	395357	39382	100
1992750921	395359	40848	100
1376651513	395360	51057	75
1376659748	395361	46098	45
1720531502	395363	45778	71
1023064193	395364	37928	100
1326035577	395365	36174	100
1194724153	395366	42010	56
1598759748	395367	50767	100
1568827921	395370	52515	70
1700875382	395371	35301	90
1952493272	395372	47267	100
1154388684	395373	51933	80
1154378941	395374	49599	100
1548254790	395375	37634	100
1437383353	395376	41428	87
1366434284	395378	37928	100
1912315649	395379	49012	89
1033114707	395380	67396	61
1134118631	395381	68561	81
1720449374	395382	59808	41
1992704589	395384	39095	80
1538133053	395386	40848	100
1700834314	395387	60392	80
1174504062	395388	47846	85
1619062858	395390	51638	81
1972509966	395391	46098	80
1750691267	395393	44931	100
1649225590	395394	46680	34
1225036478	395395	43761	100
1861431199	395396	39382	100
1952357659	395397	45222	100
1588641757	395398	31800	100
1689633943	395400	42010	75
1891786604	395401	39382	80
1245287341	395402	45222	100
1932384963	395403	59228	65
1831201946	395404	71188	70
1801830195	395405	65644	70
1174510325	395406	49306	79
1356523666	395408	58351	50
1639176977	395409	56017	75
1386637809	395410	39382	83
1043207152	395413	49599	40
1548431547	395414	40258	58
1295118396	395416	58351	66
1043268543	395418	60101	61
1417928185	395421	31224	41