You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page.
An Official
Pennsylvania
Government Website
Translate
DLI
Department of Labor & Industry
I am ...
I am ...
Claimant
Worker
Employer
Researcher
Provider
Services
Services
Unemployment Benefits
Unemployment Tax Services
Workers' Compensation
Disability Determination
Job Search & Career Training
Disability Services
Labor Law Compliance
Occ. & Industrial Safety
Document Downloads
Labor Market & Jobs Data
Divisions
Divisions
Unemployment Compensation
Unemployment Tax Services
Workers' Compensation
PA CareerLink®
PennSERVE
Vocational Rehabilitation
Work Statistics
Labor Law Compliance
Occ. & Industrial Safety
Disability Determinitation
About
About
Contact the Pennsylvania Depar
Equal Opportunity
Guide to Services
Boards
Councils and Committees
Right to Know
Search
Search
Menu
Department of Labor & Industry
Menu
I am ...
I am ...
Claimant
Worker
Employer
Researcher
Provider
Services
Services
Unemployment Benefits
Unemployment Tax Services
Workers' Compensation
Disability Determination
Job Search & Career Training
Disability Services
Labor Law Compliance
Occ. & Industrial Safety
Document Downloads
Labor Market & Jobs Data
Divisions
Divisions
Unemployment Compensation
Unemployment Tax Services
Workers' Compensation
PA CareerLink®
PennSERVE
Vocational Rehabilitation
Work Statistics
Labor Law Compliance
Occ. & Industrial Safety
Disability Determinitation
About
About
Contact the Pennsylvania Depar
Equal Opportunity
Guide to Services
Boards
Councils and Committees
Right to Know
I am a(n)...
Find Services
Bureaus & Offices
Make a Payment
Contact Us
Publications
DLI
>
Businesses
>
Workers' Compensation Services
>
Workers' Compensation
>
Health Care Services Review
>
Medical Fee Review
>
Fee Schedule
>
Fee Schedule F
Begin Main Content Area
Page Content
Content Editor
2023 Workers' Compensation Fee Schedule
Table F: Ambulatory Surgical Centers Providers
NPI or Provider #
Provider #
MSA #
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
Group 7
Group 8
Group 9
Implied Decimal 2 (in dollars)
1043204688
6644
39
81876
109637
125729
154881
176804
210296
245092
246387
271750
1710987318
16124
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1003935354
18426
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1184678682
18949
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1821098443
20055
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1265434740
20119
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1811932275
22566
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1568448660
23964
6680
83571
111900
128328
158078
180454
213738
250143
250563
277359
1336143718
25519
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1972508174
29856
2360
82977
111107
127421
156956
179182
212534
248375
249107
275400
1992784821
34270
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1467442657
34743
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1679658710
34751
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1558363549
37292
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1881662799
37513
9280
83112
111283
127620
157204
179460
212802
248766
249426
275833
1821093204
38065
39
81876
109637
125729
154881
176804
210296
245092
246387
271750
1326097536
43019
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1447220082
43308
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1922071315
43555
2360
82977
111107
127421
156956
179182
212534
248375
249107
275400
1831230788
43800
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1194790592
43822
2360
82977
111107
127421
156956
179182
212534
248375
249107
275400
1427015999
43866
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1366411829
44168
39
81876
109637
125729
154881
176804
210296
245092
246387
271750
1699743393
44397
9280
83112
111283
127620
157204
179460
212802
248766
249426
275833
1790786218
45504
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1033210760
46646
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1932153459
47292
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1326047937
48691
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1972599793
48701
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1831224922
49700
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1962405894
50342
2360
82977
111107
127421
156956
179182
212534
248375
249107
275400
1245233410
50795
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1043375702
51420
2360
82977
111107
127421
156956
179182
212534
248375
249107
275400
1639176183
52996
6680
83571
111900
128328
158078
180454
213738
250143
250563
277359
1932155470
53943
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1134114119
54109
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1164419842
54164
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1376511857
54599
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1609977610
56021
8050
85778
114858
131722
162254
185223
218230
256758
256032
284692
1801883970
56497
4000
84119
112641
129181
159122
181652
214865
251804
251939
279198
1154325686
57053
6680
83571
111900
128328
158078
180454
213738
250143
250563
277359
1437148681
57101
39
81876
109637
125729
154881
176804
210296
245092
246387
271750
1063465037
58496
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1134127426
60767
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1568469328
70683
6680
83571
111900
128328
158078
180454
213738
250143
250563
277359
1881704237
70721
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1609848472
71325
6680
83571
111900
128328
158078
180454
213738
250143
250563
277359
1669465209
72495
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1336170596
74311
4000
84119
112641
129181
159122
181652
214865
251804
251939
279198
1679544290
74442
6680
83571
111900
128328
158078
180454
213738
250143
250563
277359
1366498115
74693
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1427094945
75685
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1750356085
76416
9280
83112
111283
127620
157204
179460
212802
248766
249426
275833
1447218433
77418
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1467535773
77924
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1710091517
79180
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1902899289
81112
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1912933680
81870
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1639357338
83609
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1245331628
86445
240
86402
115696
132683
163438
186575
219504
258628
257578
286765
1164490728
87407
6680
83571
111900
128328
158078
180454
213738
250143
250563
277359
1205831849
87997
6680
83571
111900
128328
158078
180454
213738
250143
250563
277359
1346214947
88887
9280
83112
111283
127620
157204
179460
212802
248766
249426
275833
1770599136
89284
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1366451106
90375
280
83543
111862
128280
158015
180394
256068
250054
292879
307157
1053356436
90768
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1942364716
91527
3680
81959
109744
125858
155028
176982
252136
245325
288252
272017
1881687614
92397
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1679595680
94116
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1215997929
94210
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1437115094
94226
4000
84119
112641
129181
159122
181652
214865
251804
251939
279198
1548223654
94828
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1972535292
95499
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1790876431
96390
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1437104718
96963
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1639158058
97081
9280
83112
111283
127620
157204
179460
212802
248766
249426
275833
1801855127
97129
280
83543
111862
128280
158015
180394
256068
250054
292879
307157
1164458824
99333
280
83543
111862
128280
158015
180394
256068
250054
292879
307157
1558328518
101110
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1346266087
101652
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1063466118
103108
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1174634778
103445
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1821036138
104901
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1083670939
105406
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1912085333
105417
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1174525661
106979
9280
83112
111283
127620
157204
179460
212802
248766
249426
275833
1598773111
107265
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1508942665
108339
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1144380593
111569
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1851406821
111848
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1851469738
112119
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1184758948
113809
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1659408300
116237
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1134269483
116787
39
81876
109637
125729
154881
176804
210296
245092
246387
271750
1033220751
117335
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1386833044
117381
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1750592531
118416
4000
84119
112641
129181
159122
181652
214865
251804
251939
279198
1366647968
120544
4000
84119
112641
129181
159122
181652
214865
251804
251939
279198
1487857322
121009
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1689860124
122558
2360
82977
111107
127421
156956
179182
212534
248375
249107
275400
1194930925
126692
9140
81239
108776
124749
153663
175420
250216
243161
286012
298694
1457524282
136589
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1518112275
147649
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1740448711
152182
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1326298423
155088
2360
82977
111107
127421
156956
179182
212534
248375
249107
275400
1528292968
158340
6680
83571
111900
128328
158078
180454
213738
250143
250563
277359
1710114293
181696
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1497087399
185173
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1871729111
189660
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1194027920
219016
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1063715951
229887
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1215227194
238472
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1568742138
242874
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1750658092
246810
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1467715953
268481
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1679542149
300417
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1710087176
300460
2360
82977
111107
127421
156956
179182
212534
248375
249107
275400
1780664185
300696
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1245203405
300858
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1811938863
301729
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1730130246
303273
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1144434309
303298
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1306958103
303535
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1265435176
303901
39
81876
109637
125729
154881
176804
210296
245092
246387
271750
1518041979
307872
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1659463669
308187
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1578528501
308562
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1366886913
335448
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1639510175
336532
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1902140577
336657
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1649270075
337358
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1881899284
339012
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1124439450
377894
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1124210687
391021
2360
82977
111107
127421
156956
179182
212534
248375
249107
275400
1801892724
391025
9280
83112
111283
127620
157204
179460
212802
248766
249426
275833
1578567954
391027
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1134125719
391028
9280
83112
111283
127620
157204
179460
212802
248766
249426
275833
1902848260
391029
240
86402
115696
132683
163438
186575
219504
258625
257578
286765
1063477198
391030
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1831139955
391031
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1346224490
391033
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1841295201
391035
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1861462038
391036
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1184790099
391045
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1043281660
391046
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1952408783
391049
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1992768048
391050
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1174525521
391051
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1841255718
391053
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1184684573
391055
240
86402
115696
132683
163438
186575
219504
258628
257578
286765
1629153770
391056
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1255404398
391057
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1255382784
391059
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1730286097
391060
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1386602332
391061
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1922193515
391124
39
81876
109637
125729
154881
176804
210296
245092
246387
271750
1194718940
391177
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1952571028
391269
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1639317399
391274
4000
84119
112641
129181
159122
181652
214865
251804
251939
279198
1316174782
391281
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1154624526
391289
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1396012845
391302
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1104220466
391317
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1154787117
391341
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1841759040
391351
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1790251973
391352
4000
84119
112641
129181
159122
181652
214865
251804
251939
279198
1265770572
391355
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1942797535
391356
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1790265999
391357
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1235788878
391358
6680
83571
111900
128328
158078
180454
213738
250143
250563
277359
1053934919
391362
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1568060655
391367
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1326632936
391380
4000
84119
112641
129181
159122
181652
214865
251804
251939
279198
1629409578
443127
7560
82031
109837
125960
155162
177124
210600
245528
246745
272240
1821485442
462351
6280
85547
114548
131366
161820
184730
217759
256068
255458
283923
1609247741
508352
7610
82879
110973
127269
156769
178964
210711
248076
247232
275064
1851845986
555101
39
81876
109637
125729
154881
176804
210296
245092
246387
271750
1376906354
565105
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1629517271
590084
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1932613643
709983
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1013412287
768988
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1558879684
774093
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1013471754
858561
4000
84119
112641
129181
159122
181652
214865
251804
251939
279198
999990
999990
3240
84968
113767
130471
160720
183470
216575
254324
254018
281993
1366675316
BWC001
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1740823848
BWC003
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754
1477859643
BWC005
39
81876
109637
125729
154881
176804
210296
245092
246387
271750
1306434998
BWC008
6160
89413
119724
137305
169128
193076
225622
267638
265028
296754