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Fee Schedule
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Fee Schedule C Part II
Begin Main Content Area
Page Content
2022 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
27601
100
1396148726
395425
43612
100
1255345302
395426
35883
70
1265435952
395427
44718
84
1669496287
395428
34500
60
1568401800
395429
45547
100
1205822418
395430
59619
60
1609875962
395431
53827
55
1659373298
395432
54653
82
1841241171
395433
13973
100
1134662489
395434
16562
80
1205810579
395435
51344
100
1326046699
395437
31187
80
1235243742
395438
52996
94
1831192228
395439
52441
100
1336194224
395440
38645
100
1770530354
395442
45547
100
1750432019
395445
45266
59
1003810524
395446
52441
70
1093701047
395448
30636
44
1275588626
395449
49132
63
1013961952
395451
42783
100
1720400443
395454
36302
100
1154372522
395456
43309
71
1639241797
395458
43309
71
1255513651
395459
52441
91
1316063324
395460
46647
81
1710095955
395461
37815
100
1720089261
395462
61830
71
1578880837
395464
36987
80
1043215072
395465
44163
80
1669411385
395466
30085
100
1134123730
395467
43201
46
1285690792
395468
31187
100
1598254997
395469
37258
100
1962936906
395471
31741
80
1851330195
395472
41401
100
1831180173
395473
41401
75
1508865627
395474
35330
100
1841286135
395475
35605
80
1588668214
395476
31187
80
1710933429
395477
45547
100
1831258045
395478
39194
100
1285621722
395479
39885
92
1598765489
395480
46095
80
1639351943
395481
36436
98
1194776427
395482
43309
71
1578500922
395483
31187
100
1427315357
395484
38087
100
1558303982
395485
46235
80
1104840750
395489
35330
95
1508808932
395490
32571
71
1922164466
395491
52721
78
1174565824
395492
36987
80
1831498567
395493
48029
100
1740352905
395494
57687
73
1700828001
395495
52582
83
1598707119
395496
48574
83
1437154648
395497
33125
100
1356412936
395499
41405
75
1194813469
395500
49683
40
1467449322
395501
39745
58
1841202504
395502
35883
100
1487642658
395506
36712
80
1083707178
395507
72592
68
1699172494
395509
84740
83
1265504369
395510
36436
100
1952340283
395512
33125
100
1235105834
395514
45819
75
1871592816
395515
78942
69
1861492258
395518
34500
89
1891205332
395519
78108
70
1427045541
395520
41955
100
1114090412
395521
62735
71
1285095869
395524
23190
100
1720041874
395525
67624
75
1487822557
395526
46924
100
1740235613
395527
44163
100
1710971932
395530
56573
71
1669466991
395533
47297
71
1023018504
395534
26566
100
1225036544
395535
37539
100
1346356805
395536
62929
65
1740328269
395537
52167
42
1770008732
395538
50580
71
1578566725
395539
38087
96
1700831013
395540
44163
100
1689621484
395541
42783
100
1487970687
395542
26495
88
1922280239
395545
34086
80
1699750745
395549
32571
80
1487655809
395550
43057
81
1730103417
395552
31464
80
1770745598
395554
51614
86
1134164031
395555
69010
60
1497757710
395556
34223
75
1225023443
395557
37953
100
1770558512
395559
30914
100
1740261221
395560
44163
90
1023016037
395561
41401
38
1659377034
395562
57687
90
1962433797
395563
29811
100
1164907846
395564
35054
100
1104240811
395566
57961
80
1942423454
395567
26566
100
1861486003
395568
40574
80
1407952765
395570
35054
100
1598787590
395571
40298
47
1659385797
395572
38367
80
1821357799
395574
49957
95
1730177080
395575
36160
45
1487177473
395577
45547
100
1013914589
395581
37258
100
1578516423
395582
31187
100
1295718039
395583
36436
100
1043213986
395585
61276
53
1407885569
395586
70386
69
1134124480
395587
51062
68
1639612120
395588
47297
71
1184626491
395589
35054
75
1255329645
395590
36160
60
1447217112
395591
48574
100
1558817924
395592
43309
71
1760475289
395593
51062
100
1194271569
395594
43309
71
1619922267
395595
46235
69
1396109450
395596
46647
100
1124023148
395597
44434
100
1508867938
395599
52167
61
1992733984
395602
30914
38
1114958774
395603
64312
65
1619975927
395604
34223
56
1770571341
395605
75074
91
1518957497
395606
42783
100
1134672900
395607
43309
71
1578568135
395609
33953
80
1093261463
395610
42382
71
1649267477
395611
25969
100
1912011446
395612
64864
89
1285062091
395613
32297
100
1790902203
395614
25207
82
1255337523
395616
58518
46
1639169501
395617
54100
79
1487602983
395618
26224
92
1023004751
395619
44988
27
1548381031
395620
70386
98
1376610725
395621
53827
95
1881690295
395622
65416
65
1043217243
395623
23737
100
1972507531
395624
30636
54
1790783017
395625
30636
80
1528055712
395626
48029
70
1705332169
395627
44854
71
1063498160
395628
33125
50
1518941657
395629
36712
55
1174529069
395631
30914
88
1184612632
395632
55751
37
1609370741
395633
31464
80
1871584409
395634
60724
100
1235478470
395636
48029
84
1962530683
395637
35054
100
1811978398
395638
69010
100
1356331235
395640
44163
82
1669462537
395643
44718
100
1093135600
395644
33953
100
1639183817
395645
44988
75
1578069191
395646
43612
80
1093829582
395647
44988
89
1114920386
395648
36987
100
1053325951
395650
33125
81
1992280671
395651
67072
63
1750339255
395652
32850
90
1518964550
395653
70105
40
1851376370
395654
20975
100
1871591479
395656
36436
100
1336143023
395660
32571
80
1750837126
395661
42382
71
1558303206
395665
48304
97
1134662471
395670
42798
71
1972599926
395671
48396
71
1891792354
395672
33397
100
1386197168
395674
42798
71
1538612312
395675
43309
71
1588655815
395677
62104
67
1336149129
395678
27705
100
1700247376
395679
49957
70
1881691145
395680
56308
100
1225040751
395681
31464
100
1962400317
395682
59065
58
1366490864
395683
56034
100
1588668107
395684
49683
80
1336179043
395686
39745
72
1831207141
395687
43057
100
1881647899
395688
33125
100
1629064472
395690
58236
85
1457396202
395691
51614
60
1316934680
395695
46924
80
1396739546
395697
55751
70
1124522230
395698
36987
80
1083628085
395699
33953
81
1457375081
395700
33125
76