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Fee Schedule
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Fee Schedule C Part III
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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)
1659553048
395701
64185
85
1235131418
395702
43761
50
1487644225
395704
52515
100
1013921071
395705
60680
74
1902857360
395706
45778
71
1932655305
395707
45778
71
1609864859
395708
45511
100
1861492795
395710
52805
50
1932609237
395711
54911
71
1992753495
395712
14586
98
1003887415
395713
51155
71
1295753978
395715
61555
61
1972590651
395716
26257
100
1437128139
395717
45511
86
1255329918
395718
44488
72
1912905365
395719
57768
45
1487652905
395720
49306
91
1487760765
395721
57472
35
1851390421
395726
70607
72
1114937828
395728
58929
65
1447248638
395729
42302
70
1033107073
395730
30046
80
1528013349
395731
46680
100
1083718548
395732
84900
49
1487836896
395733
52515
85
1992786438
395735
46680
75
1265474910
395736
30634
85
1366443970
395738
35013
100
1720260128
395740
61555
77
1578534244
395741
93365
51
1114916780
395742
54271
40
1093761819
395743
48143
100
1518942549
395745
62140
70
1093760837
395746
45222
100
1760450779
395749
70019
55
1497731335
395751
32095
100
1669477261
395752
39970
100
1952308942
395753
45951
0
1053352666
395754
83149
48
1740280890
395756
72062
78
1801872320
395757
48722
65
1992166565
395758
28591
100
1790739795
395760
48143
100
1962444398
395762
59518
62
1790767226
395763
45809
100
1376594697
395764
52650
71
1285622456
395765
58929
87
1487697652
395767
49599
70
1114925492
395768
54849
95
1881602332
395770
32965
96
1740351584
395771
36467
80
1477531721
395772
36467
80
1376541680
395773
54849
48
1528057411
395774
46389
60
1326035973
395775
25673
80
1942283528
395778
37344
80
1043216351
395779
51933
55
1730186578
395780
42595
74
1609058007
395782
39095
85
1841245099
395783
48143
100
1659425957
395784
51638
84
1194225409
395785
35888
80
1205835642
395786
32382
80
1295722353
395787
37928
90
1487743266
395788
44636
80
1124122759
395790
44931
100
1730361049
395791
72944
60
1467459313
395793
55726
69
1740282144
395794
30923
60
1508869652
395795
46389
100
1922055029
395796
51057
100
1346243227
395797
32676
100
1578550562
395798
33839
85
1588636344
395800
52515
80
1265485734
395801
48870
43
1528059854
395802
48143
100
1417967050
395803
86358
80
1396728366
395804
56895
60
1568463818
395805
32676
80
1720083850
395806
43181
85
1184692121
395809
93066
43
1588662936
395812
82276
39
1982680633
395815
55430
90
1457355091
395816
34428
55
1770522005
395817
53973
100
1376897207
395818
42887
80
1811994460
395819
50471
100
1134103047
395821
56599
100
1275536880
395823
53686
80
1033101803
395824
28886
80
1750360285
395825
39382
90
1588603823
395826
42302
100
1598753931
395827
41428
100
1669476313
395828
57768
100
1972506954
395830
49599
80
1730361056
395831
41428
90
1497746713
395832
43181
100
1518965946
395833
37781
80
1134175102
395834
55430
100
1417967720
395838
39970
100
1801893664
395840
55430
60
1588660906
395842
43761
80
1649265414
395843
57472
56
1891810826
395844
25383
80
1982708459
395845
45511
48
1811985971
395846
39970
100
1710978226
395847
129827
50
1275530735
395848
52515
65
1649264672
395850
29468
80
1629180732
395851
79353
65
1497047310
395852
46680
80
1467456970
395853
40258
56
1548251879
395857
53391
89
1770573321
395860
73520
80
1255321436
395861
134207
35
1073500963
395864
31510
80
1770717605
395865
49599
80
1558319053
395867
19838
80
1184958308
395868
52515
70
1366442741
395870
36467
80
1659369643
395872
29761
65
1164415360
395873
72062
74
1689676991
395875
46098
75
1275590986
395876
45511
70
1396946489
395877
65644
65
1407038714
395878
49012
90
1376537431
395879
40258
48
1578561049
395880
53391
83
1528061785
395881
82860
100
1578556528
395882
75270
80
1306137088
395883
63605
80
1881670453
395889
120789
48
1861568776
395890
140332
35
1982679437
395891
62140
80
1346784022
395892
53463
71
1184791022
395894
89863
41
1306883210
395895
42302
70
1457357683
395896
47846
100
1245236488
395898
51057
100
1033107008
395899
29174
80
1821544297
395901
45778
71
1215933601
395902
51057
46
1477735793
395904
48431
100
1194145706
395905
39095
67
1407054489
395906
31800
80
1003804634
395907
55430
30
1831187079
395908
27133
80
1184672685
395909
21880
80
1376050872
395912
54911
71
1053366328
395913
75856
100
1821096801
395915
27719
80
1164416491
395916
35301
80
1437104411
395917
72944
60
1154320950
395918
26845
80
1922009679
395922
43761
80
1265499636
395923
28005
80
1114937737
395925
88109
46
1710975693
395926
100947
45
1508882002
395927
38805
80
1780129973
395930
72944
80
1891874798
395933
62432
28
1669445870
395934
117288
22
1629075163
395936
48888
94
1255513560
395939
56703
71
1700946605
395941
77024
80
1306841101
395946
181028
36
1225033392
395948
27990
80
1235198326
395951
120171
49
1558301325
395952
65332
71
1184139552
395953
53110
71
1114099215
395959
49846
71
1073572871
395964
58162
71
1396833778
395966
117882
48
1154303311
395984
65555
65
1962409060
395985
61476
71
1326023573
395987
83310
35
1679565147
395990
109260
47
1558303693
395995
110625
60
1770595415
395996
47567
71
1700870920
395998
72944
100
1083611487
396002
178680
35
1851573174
396009
65332
71
1285628404
396015
49993
71
1760664171
396017
65332
71
1649268921
396024
23914
80
1952359457
396035
53200
71
1659382455
396040
100703
80
1629076930
396048
52739
71
1235168519
396056
38805
80
1255342580
396062
49238
65
1851382014
396064
63099
65
1962404251
396065
26257
100
1184629149
396067
54598
65
1154316057
396070
72750
69
1215452271
396073
53463
71
1851398341
396074
44058
67
1023168283
396076
65934
70
1689747685
396080
53450
80
1649276742
396081
50854
80
1194716944
396089
53750
71
1437486081
396093
57312
71
1083807911
396095
51948
71
1285741900
396098
48031
80
1053380857
396100
53659
71
1922056076
396101
49238
65
1164509261
396102
59028
60
1841288214
396105
48574
71
1477591014
396108
53819
71
1588621437
396109
51579
71
1417015223
396111
61066
71
1568600849
396114
65332
71
1528377348
396126
65332
71
1750870580
396129
61327
71
1255622551
396130
52091
71
1831525179
396133
58162
60
1033530878
396134
55205
71
1790102622
396135
51579
71
1992100408
396136
71355
71
1649789884
396144
57299
71
1255846119
396145
49993
71
1588132716
396146
54568
71