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Fee Schedule
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Fee Schedule F
Begin Main Content Area
Page Content
2022 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
77461
103725
118949
146529
167270
198956
231875
233100
257096
1710987318
16124
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1003935354
18426
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1184678682
18949
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1821098443
20055
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1265434740
20119
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1811932275
22566
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1568448660
23964
6680
79064
105866
121408
149553
170723
202212
236654
237051
262402
1336143718
25519
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1972508174
29856
2360
78502
105115
120550
148492
169519
201073
234981
235674
260549
1992784821
34270
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1467442657
34743
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1679658710
34751
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1558363549
37292
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1881662799
37513
9280
78630
105282
120738
148727
169782
201326
235351
235975
260958
1821093204
38065
39
77461
103725
118949
146529
167270
198956
231875
233100
257096
1326097536
43019
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1447220082
43308
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1922071315
43555
2360
78502
105115
120550
148492
169519
201073
234981
235674
260549
1831230788
43800
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1194790592
43822
2360
78502
105115
120550
148492
169519
201073
234981
235674
260549
1427015999
43866
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1366411829
44168
39
77461
103725
118949
146529
167270
198956
231875
233100
257096
1699743393
44397
9280
78630
105282
120738
148727
169782
201326
235351
235975
260958
1790786218
45504
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1033210760
46646
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1932153459
47292
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1326047937
48691
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1972599793
48701
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1831224922
49700
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1962405894
50342
2360
78502
105115
120550
148492
169519
201073
234981
235674
260549
1245233410
50795
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1043375702
51420
2360
78502
105115
120550
148492
169519
201073
234981
235674
260549
1639176183
52996
6680
79064
105866
121408
149553
170723
202212
236654
237051
262402
1932155470
53943
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1134114119
54109
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1164419842
54164
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1376511857
54599
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1609977610
56021
8050
81152
108664
124619
153504
175235
206462
242912
242225
269340
1801883970
56497
4000
79583
106567
122215
150541
171856
203278
238225
238353
264142
1154325686
57053
6680
79064
105866
121408
149553
170723
202212
236654
237051
262402
1437148681
57101
39
77461
103725
118949
146529
167270
198956
231875
233100
257096
1063465037
58496
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1134127426
60767
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1568469328
70683
6680
79064
105866
121408
149553
170723
202212
236654
237051
262402
1881704237
70721
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1609848472
71325
6680
79064
105866
121408
149553
170723
202212
236654
237051
262402
1669465209
72495
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1336170596
74311
4000
79583
106567
122215
150541
171856
203278
238225
238353
264142
1679544290
74442
6680
79064
105866
121408
149553
170723
202212
236654
237051
262402
1366498115
74693
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1427094945
75685
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1750356085
76416
9280
78630
105282
120738
148727
169782
201326
235351
235975
260958
1447218433
77418
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1467535773
77924
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1710091517
79180
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1902899289
81112
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1912933680
81870
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1639357338
83609
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1245331628
86445
240
81743
109457
125528
154624
176514
207667
244681
243688
271301
1164490728
87407
6680
79064
105866
121408
149553
170723
202212
236654
237051
262402
1205831849
87997
6680
79064
105866
121408
149553
170723
202212
236654
237051
262402
1346214947
88887
9280
78630
105282
120738
148727
169782
201326
235351
235975
260958
1770599136
89284
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1366451106
90375
280
79038
105830
121362
149494
170666
242259
236570
277085
290593
1053356436
90768
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1942364716
91527
3680
77539
103826
119071
146668
167438
238539
232096
272708
257348
1881687614
92397
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1679595680
94116
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1215997929
94210
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1437115094
94226
4000
79583
106567
122215
150541
171856
203278
238225
238353
264142
1548223654
94828
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1972535292
95499
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1790876431
96390
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1437104718
96963
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1639158058
97081
9280
78630
105282
120738
148727
169782
201326
235351
235975
260958
1801855127
97129
280
79038
105830
121362
149494
170666
242259
236570
277085
290593
1164458824
99333
280
79038
105830
121362
149494
170666
242259
236570
277085
290593
1558328518
101110
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1346266087
101652
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1063466118
103108
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1174634778
103445
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1821036138
104901
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1083670939
105406
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1912085333
105417
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1174525661
106979
9280
78630
105282
120738
148727
169782
201326
235351
235975
260958
1598773111
107265
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1508942665
108339
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1144380593
111569
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1851406821
111848
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1851469738
112119
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1184758948
113809
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1659408300
116237
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1134269483
116787
39
77461
103725
118949
146529
167270
198956
231875
233100
257096
1033220751
117335
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1386833044
117381
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1750592531
118416
4000
79583
106567
122215
150541
171856
203278
238225
238353
264142
1366647968
120544
4000
79583
106567
122215
150541
171856
203278
238225
238353
264142
1487857322
121009
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1689860124
122558
2360
78502
105115
120550
148492
169519
201073
234981
235674
260549
1194930925
126692
9140
76858
102910
118022
145377
165960
236723
230048
270588
282587
1457524282
136589
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1518112275
147649
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1740448711
152182
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1326298423
155088
2360
78502
105115
120550
148492
169519
201073
234981
235674
260549
1528292968
158340
6680
79064
105866
121408
149553
170723
202212
236654
237051
262402
1710114293
181696
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1497087399
185173
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1871729111
189660
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1194027920
219016
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1063715951
229887
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1215227194
238472
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1568742138
242874
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1750658092
246810
240
81743
109457
125528
154624
176514
207667
244678
243688
271301
1467715953
268481
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1679542149
300417
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1710087176
300460
2360
78502
105115
120550
148492
169519
201073
234981
235674
260549
1780664185
300696
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1245203405
300858
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1811938863
301729
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1730130246
303273
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1144434309
303298
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1306958103
303535
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1265435176
303901
39
77461
103725
118949
146529
167270
198956
231875
233100
257096
1518041979
307872
3240
80386
107632
123435
152053
173576
204896
240609
240320
266786
1659463669
308187
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1578528501
308562
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1366886913
335448
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1639510175
336532
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1902140577
336657
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1649270075
337358
7560
77607
103914
119167
146795
167572
199243
232288
233439
257559
1881899284
339012
6160
84591
113268
129901
160008
182664
213455
253205
250736
280751
1124439450
377894
6280
80934
108371
124282
153094
174768
206016
242259
241682
268612
1124210687
391021
2360
78502
105115
120550
148492
169519
201073
234981
235674
260549
1801892724
391025
9280
78630
105282
120738
148727
169782
201326
235351
235975
260958
1578567954
391027
6280
80934
108371
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