2015 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)
1528039039 390127 0 0 0 0 633294 790152 88268 0
1184620486 390130 0 0 0 0 3156950 648468 45238 0
1104897529 390132 35113 15735 6485 0 1536568 790152 129538 0
1164400131 390133 96119 30636 0 2145 517000 737160 67152 0
1255585303 390137 23063 14230 635 0 455845 649650 63710 0
1821091059 390138 0 0 0 0 791148 647077 46716 0
1508971441 390139 70978 34408 0 4335 408291 790152 76773 0
1902805245 390142 369904 212140 1506 4035 365688 790152 186961 0
1689691214 390145 0 0 360 1235 427067 722071 77696 0
1659360220 390146 0 0 0 0 896975 647077 64018 0
1912905548 390147 0 0 0 0 549750 722071 77745 0
1336294719 390150 0 0 0 0 591382 647077 62831 0
1902804552 390151 0 0 0 0 640294 647077 43460 0
1215042114 390153 0 0 0 0 894406 790152 104438 0
1285639278 390154 0 0 0 0 1663757 647077 52802 0
1861486698 390156 159051 111309 1547 0 352862 790152 88766 0
1730173550 390156 159051 111309 1547 0 352862 790152 88766 0
1073598439 390157 0 0 0 35511 621777 722071 73895 0
1962401497 390160 0 0 0 0 846365 722071 73895 0
1740252964 390162 75610 51350 0 0 625314 737160 64476 0
1568577724 390163 0 0 374 0 909003 657490 57331 0
1457408973 390163 0 0 374 0 909003 657490 57331 0
1821007881 390164 429609 170349 862 7967 363586 722071 28756 220225
1144384082 390164 429609 170349 862 7967 363586 722071 28756 220225
1447317896 390168 0 0 732 0 515034 722071 14310 79325
1013098078 390169 0 0 266 0 556982 649650 47212 0
1356334510 390173 0 0 0 0 537053 691371 19628 64066
1215916002 390174 463742 229874 1399 15681 377172 790152 18963 220020
1134297393 390174 52652 34199 731 45941 383273 790152 12158 158390
1225048838 390178 28914 1845 826 0 674040 664395 62579 0
1952465890 390178 28914 1845 826 0 674040 664395 62579 0
1356333579 390179 0 0 260 41582 430116 790152 46788 68748
1134212772 390180 112319 70954 923 9057 384000 790152 84942 0
1437182847 390183 0 0 0 0 569778 647077 65422 0
1144215039 390184 0 0 0 0 815338 722071 46032 0
1548322720 390185 18769 18809 0 15960 461393 649650 57021 0
1528061314 390189 0 0 0 0 1217656 700568 64913 0
1518256726 390192 0 0 0 0 635752 649650 54671 0
1356354567 390194 0 0 0 0 565986 725487 74744 0
1245335629 390195 146350 43945 0 21370 404312 790152 64861 0
1952399933 390197 65092 34620 353 4497 455759 737160 75377 0
1548263973 390198 157011 55037 1444 0 386206 666146 37364 0
1265449870 390199 0 0 840 0 649447 647077 57383 0
1568459436 390201 0 0 0 0 473822 900773 65422 0
1225091697 390203 0 0 0 2762 460513 790152 122155 0
1124023015 390204 0 0 0 6730 410795 790152 104718 0
1184672214 390211 0 0 359 42894 516785 664395 67682 0
1144255159 390217 0 0 803 0 613350 722071 57063 0
1821015462 390219 51991 28021 360 3160 445265 722071 58466 0
1336110287 390220 0 0 0 0 469486 790152 34045 87290
1407856099 390222 0 0 0 0 402183 790152 57679 0
1245207521 390223 232106 71719 1750 19353 450145 790152 141479 0
1083615587 390225 0 0 0 0 676859 685978 66113 0
1548423684 390225 0 0 0 0 676859 685978 66113 0
1063489342 390226 0 79589 0 4412 431688 790152 6242 218808
1073587119 390228 0 0 0 0 490321 722071 76491 0
1811992084 390231 129440 54408 0 21332 366297 790152 93868 0
1730158981 390233 0 0 0 0 731036 668403 59524 0
1164421335 390236 0 0 0 0 645768 647077 66888 0
1336314384 390236 0 0 0 0 645768 647077 66888 0
1881983039 390237 15748 15537 0 1102 537339 649650 65685 0
1568435477 390256 543218 185283 516 1423 868053 700568 59837 0
1780686931 390258 0 0 0 0 941264 790152 48338 100043
1598743585 390263 13629 2497 0 0 624901 725487 58005 0
1578560504 390265 0 0 0 0 506455 722071 73895 0
1023000296 390266 0 0 0 0 889640 664395 67177 0
1679592380 390267 51991 29760 0 0 527563 722071 73895 0
1730173154 390268 0 0 0 4552 868457 714645 68885 0
1104991801 390268 0 0 0 4552 868457 714645 68885 0
1780750620 390268 0 0 0 4552 868457 714645 68885 0
1275620585 390270 0 0 0 0 415541 649650 20837 92271
1649305129 390270 0 0 0 0 415541 649650 20837 92271
1649568403 390270 0 0 0 0 415541 649650 20837 92271
1447538640 390270 0 0 0 0 415541 649650 20837 92271
1669768214 390270 0 0 0 0 415541 649650 20837 92271
1881980803 390270 0 0 0 0 415541 649650 20837 92271
1265728810 390270 0 0 0 0 415541 649650 20837 92271
1760777106 390270 0 0 0 0 415541 649650 20837 92271
1093001653 390270 0 0 0 0 415541 649650 20837 92271
1174822068 390270 0 0 0 0 415541 649650 20837 92271
1861791865 390270 0 0 0 0 415541 649650 20837 92271
1235424672 390270 0 0 0 0 415541 649650 20837 92271
1205197894 390270 0 0 0 0 415541 649650 20837 92271
390272 390272 0 0 500 0 0 790152 29630 0
1467510560 390278 0 0 9140 0 0 790152 111622 0
1023033792 390290 402638 145927 1513 4863 330477 790152 128642 0
1043240351 390302 0 0 0 0 412000 790152 80473 0
1821020421 390304 0 0 294 52838 496395 790152 133872 0
1780919043 390307 0 0 0 0 403000 664395 67177 0
1659392595 390307 0 0 0 0 403000 664395 67177 0
1427097864 390314 0 0 0 0 300000 725487 73181 0
1124193511 390316 0 0 0 0 300000 676368 68370 0
1043456957 390321 0 0 0 0 284000 737160 73203 0
1336378132 390322 0 0 0 0 284000 790152 80473 0
1528398534 390323 0 0 0 0 278000 722071 73893 0
1265664544 390324 0 0 0 0 271000 790152 80473 0
1578881652 390325 0 0 0 0 271000 668403 67573 0
1962758375 390325 0 0 0 0 271000 668403 67573 0
1497050470 390326 0 0 0 0 271000 737160 73203 0
1760787576 390327 0 0 0 0 407000 668403 67573 0
1225323983 390328 0 0 0 0 268000 722071 73895 0
1104192590 390329 0 0 0 0 268000 790152 80473 0
999993 999993 75972 37367 433 8021 431343 700568 70751 0
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