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Health Care Services Review
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Fee Schedule
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Fee Schedule C Part I
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Content Editor
2024 Workers' Compensation Fee Schedule
Table C: Skilled Nursing Facilities
NPI or Provider #
Provider #
In-Patient Allowance
Out-Patient Allowance
Implied Decimal 2 (in dollars)
1306844295
395001
58863
91
1679575989
395003
52188
100
1376533109
395006
67058
100
1265474753
395010
42778
100
1295165223
395011
89207
60
1023015138
395012
33677
100
1659875789
395013
40054
80
1871916874
395015
55602
71
1154321008
395016
43994
40
1629015078
395018
74944
80
1477565216
395020
37017
80
1245238724
395023
51126
92
1558702381
395028
87082
88
1487175816
395031
56738
63
1285619601
395032
69177
70
1629074935
395034
39445
100
1215984935
395037
43994
100
1770072175
395041
51755
71
1063418150
395042
30341
70
1396166617
395044
23362
80
1447245337
395045
45820
69
1922005271
395047
48547
70
1497750053
395050
47031
100
1629063250
395052
48547
94
1346238672
395058
41868
100
1467400960
395066
64929
90
1194015784
395067
34284
100
1194064683
395075
67360
65
1477735785
395077
71606
65
1245327428
395078
64626
60
1982602447
395080
55833
91
1902806854
395090
29433
80
1649228149
395092
17597
80
1053318501
395094
30041
80
1376664839
395095
54616
77
1033115514
395101
30647
100
1285744474
395102
33379
100
1235137472
395103
34587
100
1104829571
395104
39139
80
1356323109
395105
55527
94
1225034440
395108
50069
100
1134177637
395109
40659
80
1770562688
395110
74338
100
1316002355
395117
41569
100
1003809526
395118
56132
91
1437146917
395121
44299
100
1124079587
395123
13653
100
1205062585
395124
31553
80
1376530469
395134
57347
100
1851573166
395135
29433
100
1063694370
395138
56132
75
1538119573
395142
49213
71
1477657955
395146
67661
100
1518049899
395148
40957
100
1811208077
395155
69177
24
1225017130
395156
63716
80
1710348305
395158
51583
60
1326046061
395160
43390
70
1801894712
395164
79799
88
1053746222
395166
43390
71
1124535174
395167
58752
71
1255320032
395168
56738
45
1518951763
395171
45820
64
1205841632
395172
47031
70
1760622161
395173
71911
50
1093219040
395174
47331
83
1063711786
395176
48696
83
1932150349
395177
50762
71
1508857897
395180
38232
80
1205903630
395182
50069
67
1699738732
395188
87381
95
1093766305
395193
54756
71
1528429107
395197
44602
61
1518913136
395199
39445
100
1275086050
395200
15464
100
1821261710
395202
57647
50
1134113293
395203
50217
84
1295735157
395205
52798
60
1386616068
395206
43390
80
1306340435
395208
51885
73
1396708467
395217
72820
95
1477665198
395218
35805
80
1669423992
395223
49213
71
1386826691
395224
50368
88
1386151884
395226
52876
71
1851396972
395227
71004
55
1992729305
395228
40957
80
1184869877
395231
47031
100
1710982392
395232
49760
100
1730182189
395235
47942
78
1730540428
395237
57647
100
1679028088
395241
16084
80
1750563060
395243
44602
70
1649277625
395244
37621
100
1619928074
395247
12744
100
1255323986
395248
47331
65
1780639872
395249
54824
71
1255338976
395250
49158
85
1386695617
395252
47609
71
1558312959
395256
54756
71
1992709414
395258
66149
75
1013417328
395259
65493
71
1528068012
395260
33379
100
1033529490
395261
47331
75
1295281665
395262
18206
80
1518461565
395266
55403
71
1629110754
395270
52188
82
1902857212
395273
47609
71
1326033556
395276
62808
51
1033160494
395277
54756
71
1649279142
395278
49760
75
1619951993
395282
44457
100
1053317446
395283
44908
63
1841241254
395284
54756
71
1083632202
395285
37621
58
1033619333
395286
50624
86
1992756225
395288
47609
71
1932642287
395289
66650
100
1619459351
395290
44602
66
1518919778
395292
42778
86
1942743299
395295
16687
80
1093181752
395296
63780
71
1275581779
395298
45511
65
1407832843
395300
87381
53
1538103270
395305
56132
99
1023005766
395306
33072
41
1255312138
395307
54616
100
1073518213
395308
85862
80
1679520266
395309
51583
100
1801195524
395311
63716
35
1730137233
395313
37324
75
1497837470
395316
57347
40
1750622601
395317
44602
36
1699772327
395318
54010
100
1518915792
395319
69788
95
1184619736
395321
47641
100
1477540524
395324
60381
86
1831184506
395325
45511
100
1417937624
395326
39139
55
1013912500
395328
43994
75
1548268840
395329
42326
100
1598749558
395330
48696
100
1992209027
395331
71609
86
1093973158
395332
68270
55
1992758205
395333
54313
57
1386157485
395334
63780
71
1548716913
395335
49213
71
1699773655
395336
38838
39
1780751115
395338
46120
75
1104867902
395342
91026
60
1508813460
395344
42482
100
1194200873
395345
57647
60
1851395396
395346
52490
45
1578520011
395347
59171
65
1851346704
395348
50069
100
1891806980
395349
46120
100
1265448690
395350
30341
85
1720034002
395351
45511
100
1528139078
395352
53265
71
1760479893
395353
26177
80
1871775197
395354
45665
84
1124014691
395355
57043
80
1740287499
395356
22755
80
1366446288
395357
40957
100
1992750921
395359
42482
100
1376651513
395360
53099
75
1376659748
395361
47942
45
1720531502
395363
47609
71
1023064193
395364
39445
100
1326035577
395365
37621
100
1194724153
395366
43690
56
1598759748
395367
52798
100
1568827921
395370
54616
70
1700875382
395371
36713
90
1952493272
395372
49158
100
1154388684
395373
54010
80
1154378941
395374
51583
100
1548254790
395375
39139
100
1437383353
395376
43085
87
1366434284
395378
39445
100
1912315649
395379
50972
89
1033114707
395380
70092
61
1134118631
395381
71303
81
1720449374
395382
62200
41
1992704589
395384
40659
80
1538133053
395386
42482
100
1700834314
395387
62808
80
1174504062
395388
49760
85
1619062858
395390
53704
81
1972509966
395391
47942
80
1750691267
395393
46728
100
1649225590
395394
48547
34
1225036478
395395
45511
100
1861431199
395396
40957
100
1952357659
395397
47031
100
1588641757
395398
33072
100
1689633943
395400
43690
75
1891786604
395401
40957
80
1245287341
395402
47031
100
1932384963
395403
61597
65
1831201946
395404
74036
70
1801830195
395405
68270
70
1174510325
395406
51278
79
1356523666
395408
60685
50
1639176977
395409
58258
75
1386637809
395410
40957
83
1043207152
395413
51583
40
1548431547
395414
41868
58
1295118396
395416
60685
66
1043268543
395418
62505
61
1417928185
395421
32473
41