2024 Workers' Compensation Fee Schedule

Table C, Part I: 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

Table C, Part I: Skilled Nursing Facilities

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