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Fee Schedule
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Fee Schedule C Part II
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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)
1134135577
395422
29174
100
1396148726
395425
46098
100
1255345302
395426
37928
70
1265435952
395427
47267
84
1669496287
395428
36467
60
1568401800
395429
48143
100
1205822418
395430
63017
60
1609875962
395431
56895
55
1659373298
395432
57768
82
1841241171
395433
14769
100
1134662489
395434
17506
80
1205810579
395435
54271
100
1326046699
395437
32965
80
1235243742
395438
56017
94
1831192228
395439
55430
100
1336194224
395440
40848
100
1770530354
395442
48143
100
1750432019
395445
47846
59
1003810524
395446
55430
70
1093701047
395448
32382
44
1275588626
395449
51933
63
1013961952
395451
45222
100
1720400443
395454
38371
100
1154372522
395456
45778
71
1639241797
395458
45778
71
1255513651
395459
55430
91
1316063324
395460
49306
81
1710095955
395461
39970
100
1720089261
395462
65354
71
1578880837
395464
39095
80
1043215072
395465
46680
80
1669411385
395466
31800
100
1134123730
395467
45663
46
1285690792
395468
32965
100
1598254997
395469
39382
100
1962936906
395471
33550
80
1851330195
395472
43761
100
1831180173
395473
43761
75
1508865627
395474
37344
100
1841286135
395475
37634
80
1588668214
395476
32965
80
1710933429
395477
48143
100
1831258045
395478
41428
100
1285621722
395479
42158
92
1598765489
395480
48722
80
1639351943
395481
38513
98
1194776427
395482
45778
71
1578500922
395483
32965
100
1427315357
395484
40258
100
1558303982
395485
48870
80
1104840750
395489
37344
95
1508808932
395490
34428
71
1922164466
395491
55726
78
1174565824
395492
39095
80
1831498567
395493
50767
100
1053802058
395494
60975
73
1700828001
395495
55579
83
1598707119
395496
51343
83
1437154648
395497
35013
100
1457851768
395499
43765
75
1194813469
395500
52515
40
1467449322
395501
42010
58
1841202504
395502
37928
100
1487642658
395506
38805
80
1083707178
395507
76730
68
1538676036
395509
89570
83
1265504369
395510
38513
100
1952340283
395512
35013
100
1235105834
395514
48431
75
1871592816
395515
83442
69
1861492258
395518
36467
89
1891205332
395519
82560
70
1427045541
395520
44346
100
1922508225
395521
66311
71
1285095869
395524
24512
100
1720041874
395525
71479
75
1487822557
395526
49599
100
1740235613
395527
46680
100
1710971932
395530
59798
71
1669466991
395533
49993
71
1023018504
395534
28080
100
1225036544
395535
39679
100
1346356805
395536
66516
65
1740328269
395537
55141
42
1770008732
395538
53463
71
1578566725
395539
40258
96
1700831013
395540
46680
100
1689621484
395541
45222
100
1487970687
395542
28005
88
1922280239
395545
36029
80
1699750745
395549
34428
80
1487655809
395550
45511
81
1730103417
395552
33257
80
1770745598
395554
54556
86
1134164031
395555
72944
60
1497757710
395556
36174
75
1225023443
395557
40116
100
1770558512
395559
32676
100
1740261221
395560
46680
90
1023016037
395561
43761
38
1659377034
395562
60975
90
1962433797
395563
31510
100
1164907846
395564
37052
100
1104240811
395566
61265
80
1942423454
395567
28080
100
1861486003
395568
42887
80
1407952765
395570
37052
100
1598787590
395571
42595
47
1659385797
395572
40554
80
1821357799
395574
52805
95
1730177080
395575
38221
45
1487177473
395577
48143
100
1013914589
395581
39382
100
1700393204
395582
32965
100
1295718039
395583
38513
100
1043213986
395585
64769
53
1407885569
395586
74398
69
1134124480
395587
53973
68
1639612120
395588
49993
71
1184626491
395589
37052
75
1255329645
395590
38221
60
1447217112
395591
51343
100
1558817924
395592
45778
71
1760475289
395593
53973
100
1194271569
395594
45778
71
1619922267
395595
48870
69
1396109450
395596
49306
100
1124023148
395597
46967
100
1508867938
395599
55141
61
1992733984
395602
32676
38
1114958774
395603
67978
65
1619975927
395604
36174
56
1770571341
395605
79353
91
1518957497
395606
45222
100
1134672900
395607
45778
71
1578568135
395609
35888
80
1093261463
395610
44798
71
1649267477
395611
27449
100
1912011446
395612
68561
89
1285062091
395613
34138
100
1790902203
395614
26644
82
1255337523
395616
61854
46
1639169501
395617
57184
79
1487602983
395618
27719
92
1023004751
395619
47552
27
1548381031
395620
74398
98
1376610725
395621
56895
95
1881690295
395622
69145
65
1043217243
395623
25090
100
1972507531
395624
32382
54
1790783017
395625
32382
80
1528055712
395626
50767
70
1705332169
395627
47411
71
1063498160
395628
35013
50
1518941657
395629
38805
55
1174529069
395631
32676
88
1184612632
395632
58929
37
1609370741
395633
33257
80
1871584409
395634
64185
100
1235478470
395636
50767
84
1962530683
395637
37052
100
1811978398
395638
72944
100
1356331235
395640
46680
82
1669462537
395643
47267
100
1093135600
395644
35888
100
1639183817
395645
47552
75
1578069191
395646
46098
80
1093829582
395647
47552
89
1114920386
395648
39095
100
1053325951
395650
35013
81
1992280671
395651
70895
63
1750339255
395652
34722
90
1518964550
395653
74101
40
1851376370
395654
22171
100
1871591479
395656
38513
100
1336143023
395660
34428
80
1750837126
395661
44798
71
1558303206
395665
51057
97
1134662471
395670
45237
71
1972599926
395671
51155
71
1891792354
395672
35301
100
1386197168
395674
45237
71
1538612312
395675
45778
71
1588655815
395677
65644
67
1336149129
395678
29284
100
1700247376
395679
52805
70
1881691145
395680
59518
100
1225040751
395681
33257
100
1962400317
395682
62432
58
1366490864
395683
59228
100
1588668107
395684
52515
80
1336179043
395686
42010
72
1831207141
395687
45511
100
1881647899
395688
35013
100
1629064472
395690
61555
85
1457396202
395691
54556
60
1275995755
395695
49599
80
1396739546
395697
58929
70
1124522230
395698
39095
80
1083628085
395699
35888
81
1457375081
395700
35013
76