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Fee Schedule
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Fee Schedule C Part III
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)
1659553048
395701
60724
85
1235131418
395702
41401
50
1487644225
395704
49683
100
1013921071
395705
57408
74
1902857360
395706
43309
71
1932655305
395707
43309
71
1609864859
395708
43057
100
1861492795
395710
49957
50
1992753495
395712
13799
98
1003887415
395713
48396
71
1295753978
395715
58236
61
1972590651
395716
24841
100
1437128139
395717
43057
86
1255329918
395718
42089
72
1912905365
395719
54653
45
1487652905
395720
46647
91
1487760765
395721
54373
35
1851390421
395726
66799
72
1114937828
395728
55751
65
1447248638
395729
40021
70
1033107073
395730
28426
80
1528013349
395731
44163
100
1083718548
395732
80322
49
1487836896
395733
49683
85
1992786438
395735
44163
75
1265474910
395736
28982
85
1366443970
395738
33125
100
1720260128
395740
58236
77
1578534244
395741
88330
51
1114916780
395742
51344
40
1093761819
395743
45547
100
1518942549
395745
58789
70
1093760837
395746
42783
100
1760450779
395749
66243
55
1497731335
395751
30364
100
1669477261
395752
37815
100
1952308942
395753
43473
0
1053352666
395754
78665
48
1740280890
395756
68176
78
1801872320
395757
46095
65
1992166565
395758
27049
100
1790739795
395760
45547
100
1962444398
395762
56308
62
1790767226
395763
43339
100
1376594697
395764
49811
71
1285622456
395765
55751
87
1487697652
395767
46924
70
1114925492
395768
51891
95
1881602332
395770
31187
96
1740351584
395771
34500
80
1477531721
395772
34500
80
1376541680
395773
51891
48
1528057411
395774
43887
60
1326035973
395775
24289
80
1942283528
395778
35330
80
1043216351
395779
49132
55
1730186578
395780
40298
74
1609058007
395782
36987
85
1841245099
395783
45547
100
1659425957
395784
48853
84
1194225409
395785
33953
80
1205835642
395786
30636
80
1295722353
395787
35883
90
1487743266
395788
42229
80
1124122759
395790
42508
100
1730361049
395791
69010
60
1467459313
395793
52721
69
1740282144
395794
29255
60
1508869652
395795
43887
100
1922055029
395796
48304
100
1346243227
395797
30914
100
1578550562
395798
32014
85
1588636344
395800
49683
80
1265485734
395801
46235
43
1528059854
395802
45547
100
1417967050
395803
81701
80
1396728366
395804
53827
60
1568463818
395805
30914
80
1720083850
395806
40852
85
1184692121
395809
88047
43
1588662936
395812
77839
39
1982680633
395815
52441
90
1457355091
395816
32571
55
1770522005
395817
51062
100
1376897207
395818
40574
80
1811994460
395819
47749
100
1134103047
395821
53547
100
1275536880
395823
50791
80
1033101803
395824
27328
80
1750360285
395825
37258
90
1588603823
395826
40021
100
1598753931
395827
39194
100
1669476313
395828
54653
100
1972506954
395830
46924
80
1730361056
395831
39194
90
1497746713
395832
40852
100
1518965946
395833
35744
80
1134175102
395834
52441
100
1417967720
395838
37815
100
1801893664
395840
52441
60
1588660906
395842
41401
80
1649265414
395843
54373
56
1891810826
395844
24014
80
1982708459
395845
43057
48
1811985971
395846
37815
100
1710978226
395847
122826
50
1275530735
395848
49683
65
1649264672
395850
27879
80
1629180732
395851
75074
65
1497047310
395852
44163
80
1467456970
395853
38087
56
1548251879
395857
50512
89
1770573321
395860
69555
80
1255321436
395861
126970
35
1073500963
395864
29811
80
1770717605
395865
46924
80
1558319053
395867
18768
80
1184958308
395868
49683
70
1366442741
395870
34500
80
1659369643
395872
28156
65
1164415360
395873
68176
74
1689676991
395875
43612
75
1275590986
395876
43057
70
1396946489
395877
62104
65
1407038714
395878
46369
90
1376537431
395879
38087
48
1578561049
395880
50512
83
1528061785
395881
78392
100
1578556528
395882
71211
80
1306137088
395883
60175
80
1881670453
395889
114275
48
1861568776
395890
132764
35
1982679437
395891
58789
80
1346784022
395892
50580
71
1184791022
395894
85017
41
1306883210
395895
40021
70
1457357683
395896
45266
100
1245236488
395898
48304
100
1033107008
395899
27601
80
1821544297
395901
43309
71
1215933601
395902
48304
46
1477735793
395904
45819
100
1194145706
395905
36987
67
1407054489
395906
30085
80
1003804634
395907
52441
30
1831187079
395908
25670
80
1184672685
395909
20700
80
1053366328
395913
71765
100
1821096801
395915
26224
80
1164416491
395916
33397
80
1437104411
395917
69010
60
1154320950
395918
25397
80
1922009679
395922
41401
80
1265499636
395923
26495
80
1114937737
395925
83358
46
1710975693
395926
95503
45
1508882002
395927
36712
80
1780129973
395930
69010
80
1891874798
395933
59065
28
1669445870
395934
110963
22
1629075163
395936
46252
94
1255513560
395939
53645
71
1700946605
395941
72870
80
1306841101
395946
171266
36
1225033392
395948
26481
80
1235198326
395951
113691
49
1558301325
395952
61809
71
1184139552
395953
50246
71
1114099215
395959
47158
71
1073572871
395964
55026
71
1396833778
395966
111525
48
1154303311
395984
62020
65
1962409060
395985
58161
71
1326023573
395987
78817
35
1679565147
395990
103368
47
1558303693
395995
104659
60
1770595415
395996
45002
71
1700870920
395998
69010
100
1083611487
396002
169044
35
1851573174
396009
61809
71
1285628404
396015
47297
71
1760664171
396017
61809
71
1649268921
396024
22624
80
1952359457
396035
50331
71
1659382455
396040
95272
80
1629076930
396048
49895
71
1235168519
396056
36712
80
1255342580
396062
46583
65
1851382014
396064
59696
65
1962404251
396065
24841
100
1184629149
396067
51654
65
1154316057
396070
68827
69
1215452271
396073
50580
71
1851398341
396074
41682
67
1023168283
396076
62378
70
1689747685
396080
50568
80
1649276742
396081
48112
80
1194716944
396089
50851
71
1437486081
396093
54221
71
1083807911
396095
49147
71
1285741900
396098
45441
80
1053380857
396100
50765
71
1922056076
396101
46583
65
1164509261
396102
55845
60
1841288214
396105
45955
71
1477591014
396108
50917
71
1588621437
396109
48798
71
1417015223
396111
57773
71
1568600849
396114
61809
71
1528377348
396126
61809
71
1750870580
396129
58020
71
1255622551
396130
49282
71
1831525179
396133
55026
60
1033530878
396134
52228
71
1790102622
396135
48798
71
1992100408
396136
67507
71
1649789884
396144
54209
71
1255846119
396145
47297
71
1588132716
396146
51625
71
999995
999995
41401
71