2014 Workers' Compensation Fee Schedule

Table A: Prospective Payment System

NPI or Provider # Provider # Indirect Medical Education Add-On Direct Medical Education Add-On Disproportionate Share Add-On Paramedical Education Add-On Aggregate RCC DRG Rate Capital Rate Hold Harmless Rate
Implied Decimal 6 (in percentages) Implied Decimal 4 (in percentages) Implied Decimal 6 (in percentages) Implied Decimal 2 (in dollars)
1366444507 390001 36081 15591 646 36277 485198 636912 16346 123452
1194734798 390002 135468 52932 414 0 551833 707913 66917 0
1942364898 390002 135468 52932 414 0 551833 707913 66917 0
1821198755 390003 0 0 297 0 579483 636912 62217 0
1881690212 390004 0 0 0 1397 498517 686831 54738 0
1235215427 390006 263657 107593 444 15014 508391 636912 55234 0
1033491741 390006 263657 107593 444 15014 508391 636912 55234 0
1982988408 390006 263657 107593 444 15014 508391 636912 55234 0
1417231937 390006 263657 107593 444 15014 508391 636912 55234 0
1275832164 390006 263657 107593 444 15014 508391 636912 55234 0
1457650343 390006 263657 107593 444 15014 508391 636912 55234 0
1427344969 390006 263657 107593 444 15014 508391 636912 55234 0
1154617694 390006 263657 107593 444 15014 508391 636912 55234 0
1467748475 390006 263657 107593 444 15014 508391 636912 55234 0
1063708501 390006 263657 107593 444 15014 508391 636912 55234 0
1770879215 390006 263657 107593 444 15014 508391 636912 55234 0
1275850620 390006 263657 107593 444 15014 508391 636912 55234 0
1528197720 390006 263657 107593 444 15014 508391 636912 55234 0
1063540011 390006 263657 107593 444 15014 508391 636912 55234 0
1851508162 390006 263657 107593 444 15014 508391 636912 55234 0
1669768289 390006 263657 107593 444 15014 508391 636912 55234 0
1710087069 390008 0 0 0 0 642456 707913 55233 0
1861435042 390009 35262 16381 283 16884 388855 653084 69408 0
1386896306 390012 0 0 0 0 681384 774659 68961 0
1124076039 390013 0 0 0 0 770580 634389 43019 0
1477538312 390016 0 0 383 46405 645555 707913 72446 0
1750488995 390019 0 0 0 0 585491 711262 53305 0
1356313464 390026 102863 44440 0 0 700974 774659 55067 0
1962579029 390027 369197 164426 3735 1000 346350 774659 36756 166432
1881695146 390028 212670 105091 638 19969 407418 707913 76832 0
1568526135 390028 212670 105091 638 19969 407418 707913 76832 0
1235138405 390030 0 0 0 36715 651378 634389 64139 0
1427050376 390031 0 0 0 0 506323 634389 16107 68827
1689679581 390032 0 0 0 6702 511963 707913 72446 0
1669405072 390035 0 0 0 0 361107 774659 78895 0
1063422053 390036 39427 27555 0 969 537674 707913 33331 60262
1588770416 390037 0 0 0 43300 635158 707913 74457 0
1912900168 390039 0 0 825 2588 541040 645980 68937 0
1871594127 390041 0 0 841 23769 496716 707913 72446 0
1609984889 390042 43209 30912 256 42196 0 707913 72446 0
1740298017 390043 0 0 0 0 551130 634389 40497 0
1669530069 390044 84971 23313 0 21042 1186896 663106 57620 0
1609801976 390045 44467 21869 287 5640 402000 626177 12843 101908
1326060492 390046 144496 64117 259 5922 604415 655297 51576 0
1861545683 390048 8240 34578 0 0 1965165 634389 62704 0
1013933175 390049 68656 32236 0 133798 607630 722706 71768 0
1548293954 390049 68656 32236 0 133798 607630 722706 71768 0
1285667493 390050 248542 77734 534 3112 387091 707913 36446 90780
1427022078 390052 0 0 0 4853 513732 634389 48287 0
1700878840 390056 0 0 0 0 597279 634389 9186 144895
1568459287 390057 0 0 0 0 450593 774659 85179 0
1730133844 390058 0 0 0 3047 554630 686831 57268 0
1467491027 390061 0 0 286 18710 628825 672527 71440 0
1497708473 390062 0 0 0 0 1116623 665371 65842 0
1487647590 390063 52946 32583 539 6973 397020 653084 66025 0
1265466957 390065 0 0 0 0 736431 772969 78737 0
1407928500 390066 39353 17255 0 0 492272 686831 53451 0
1407813603 390067 130828 52674 433 2232 445000 686831 61145 0
1770539637 390068 58594 33076 854 0 193955 672527 68740 0
1528319621 390070 9153 2964 0 0 431480 774659 45365 0
1144291840 390071 0 0 0 0 1179577 634389 63138 0
1316919699 390072 0 0 710 0 519617 636912 58942 0
1649278730 390073 37941 30974 410 25331 446000 665371 67254 0
1083685622 390076 0 0 411 33214 487369 774659 31126 118334
1083614382 390079 112108 37346 0 20184 634945 634389 21376 128921
1912902206 390080 7099 5644 0 0 387978 774659 23229 134356
1073606737 390081 29962 0 0 0 351953 774659 55908 0
1467424820 390084 0 0 0 0 554025 634389 44294 0
1144249657 390086 0 0 400 0 677485 634389 62710 0
1194744805 390090 174532 60762 649 37073 356554 707913 72446 0
1619069440 390091 0 0 0 3356 597181 634389 67363 0
1265422901 390093 30411 20351 0 0 620784 634389 4777 92982
1699734665 390096 26367 33298 859 3219 528137 663106 22668 62785
1750371522 390097 0 0 0 570 357027 774659 69897 0
1104875103 390100 56910 18259 0 19607 724335 672527 49436 0
1043585524 390101 92128 52381 390 0 497259 655297 46886 0
1790795359 390102 110841 116437 0 14691 462514 707913 77289 0
1750445607 390102 110841 116437 0 14691 462514 707913 77289 0
1861478307 390104 0 0 0 0 0 698915 64139 0
1225047699 390107 0 0 0 0 560569 707913 57291 0
1639218936 390107 0 0 0 0 560569 707913 57291 0
1801897038 390110 126380 68584 690 37359 416925 635753 21666 86764
1851370910 390111 539305 313211 1585 7937 321731 774659 20489 265151
1275620536 390112 0 0 0 0 607604 635753 6641 76524
1942276423 390113 0 0 1000 0 802026 648580 57563 0
1952311508 390114 147995 110633 1702 0 479453 707913 30033 121726
1659435501 390114 147995 110633 1702 0 479453 707913 30033 121726
1801963343 390115 60642 41217 671 31461 288789 774659 43367 75846
1114095791 390115 60642 41217 671 31461 288789 774659 43367 75846
1205904885 390115 60642 41217 671 31461 288789 774659 43367 75846
1215952106 390115 60642 41217 671 31461 288789 774659 43367 75846
1225022064 390116 219851 95443 268 894 449520 774659 82902 122544
1295724193 390117 0 0 0 0 726684 634389 51561 0
1578569885 390118 0 0 0 0 414013 634389 55014 0
1922376136 390119 24716 27385 0 0 428010 636912 5621 114388
1891899332 390122 0 0 0 0 605943 634389 51152 0
1891768099 390123 0 0 0 0 475055 774659 68801 0
1124026182 390125 0 0 0 0 562680 634389 64139 0
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