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)
1528039039 390127 0 0 0 0 633294 774659 86537 0
1184620486 390130 0 0 0 0 3156950 635753 44351 0
1104897529 390132 35113 15735 6485 0 1536568 774659 126998 0
1164400131 390133 96119 30636 0 2145 517000 722706 65835 0
1255585303 390137 23063 14230 635 0 455845 636912 62461 0
1821091059 390138 0 0 0 0 791148 634389 45800 0
1508971441 390139 70978 34408 0 4335 408291 774659 75268 0
1902805245 390142 369904 212140 1506 4035 365688 774659 183295 0
1689691214 390145 0 0 360 1235 427067 707913 76173 0
1659360220 390146 0 0 0 0 896975 634389 62763 0
1912905548 390147 0 0 0 0 549750 707913 76221 0
1336294719 390150 0 0 0 0 591382 634389 61599 0
1902804552 390151 0 0 0 0 640294 634389 42608 0
1215042114 390153 0 0 0 0 894406 774659 102390 0
1285639278 390154 0 0 0 0 1663757 634389 51767 0
1861486698 390156 159051 111309 1547 0 352862 774659 87025 0
1730173550 390156 159051 111309 1547 0 352862 774659 87025 0
1073598439 390157 0 0 0 35511 621777 707913 72446 0
1962401497 390160 0 0 0 0 846365 707913 72446 0
1740252964 390162 75610 51350 0 0 625314 722706 63212 0
1568577724 390163 0 0 374 0 909003 644598 56207 0
1457408973 390163 0 0 374 0 909003 644598 56207 0
1821007881 390164 429609 170349 862 7967 363586 707913 28192 215907
1144384082 390164 429609 170349 862 7967 363586 707913 28192 215907
1447317896 390168 0 0 732 0 515034 707913 14029 77770
1013098078 390169 0 0 266 0 556982 636912 46286 0
1356334510 390173 0 0 0 0 537053 677815 19243 62810
1215916002 390174 463742 229874 1399 15681 377172 774659 18591 215706
1134297393 390174 52652 34199 731 45941 383273 774659 11920 155284
1225048838 390178 28914 1845 826 0 674040 651368 61352 0
1952465890 390178 28914 1845 826 0 674040 651368 61352 0
1356333579 390179 0 0 260 41582 430116 774659 45871 67400
1134212772 390180 112319 70954 923 9057 384000 774659 83276 0
1437182847 390183 0 0 0 0 569778 634389 64139 0
1144215039 390184 0 0 0 0 815338 707913 45129 0
1548322720 390185 18769 18809 0 15960 461393 636912 55903 0
1528061314 390189 0 0 0 0 1217656 686831 63640 0
1518256726 390192 0 0 0 0 635752 636912 53599 0
1356354567 390194 0 0 0 0 565986 711262 73278 0
1245335629 390195 146350 43945 0 21370 404312 774659 63589 0
1952399933 390197 65092 34620 353 4497 455759 722706 73899 0
1548263973 390198 157011 55037 1444 0 386206 653084 36631 0
1265449870 390199 0 0 840 0 649447 634389 56258 0
1568459436 390201 0 0 0 0 473822 883111 64139 0
1225091697 390203 0 0 0 2762 460513 774659 119760 0
1124023015 390204 0 0 0 6730 410795 774659 102665 0
1184672214 390211 0 0 359 42894 516785 651368 66355 0
1144255159 390217 0 0 803 0 613350 707913 55944 0
1821015462 390219 51991 28021 360 3160 445265 707913 57320 0
1336110287 390220 0 0 0 0 469486 774659 33377 85578
1407856099 390222 0 0 0 0 402183 774659 56548 0
1245207521 390223 232106 71719 1750 19353 450145 774659 138705 0
1083615587 390225 0 0 0 0 676859 672527 64817 0
1548423684 390225 0 0 0 0 676859 672527 64817 0
1063489342 390226 0 79589 0 4412 431688 774659 6120 214518
1073587119 390228 0 0 0 0 490321 707913 74991 0
1811992084 390231 129440 54408 0 21332 366297 774659 92027 0
1730158981 390233 0 0 0 0 731036 655297 58357 0
1164421335 390236 0 0 0 0 645768 634389 65576 0
1336314384 390236 0 0 0 0 645768 634389 65576 0
390237 390237 15748 15537 0 1102 537339 636912 64397 0
1568435477 390256 543218 185283 516 1423 868053 686831 58664 0
1780686931 390258 0 0 0 0 941264 774659 47390 98081
1598743585 390263 13629 2497 0 0 624901 711262 56868 0
1578560504 390265 0 0 0 0 506455 707913 72446 0
1023000296 390266 0 0 0 0 889640 651368 65860 0
1679592380 390267 51991 29760 0 0 527563 707913 72446 0
1730173154 390268 0 0 0 4552 868457 700632 67534 0
1104991801 390268 0 0 0 4552 868457 700632 67534 0
1780750620 390268 0 0 0 4552 868457 700632 67534 0
1275620585 390270 0 0 0 0 415541 636912 20428 90462
1649305129 390270 0 0 0 0 415541 636912 20428 90462
1649568403 390270 0 0 0 0 415541 636912 20428 90462
1447538640 390270 0 0 0 0 415541 636912 20428 90462
1669768214 390270 0 0 0 0 415541 636912 20428 90462
1881980803 390270 0 0 0 0 415541 636912 20428 90462
1265728810 390270 0 0 0 0 415541 636912 20428 90462
1760777106 390270 0 0 0 0 415541 636912 20428 90462
1093001653 390270 0 0 0 0 415541 636912 20428 90462
1174822068 390270 0 0 0 0 415541 636912 20428 90462
1861791865 390270 0 0 0 0 415541 636912 20428 90462
1235424672 390270 0 0 0 0 415541 636912 20428 90462
1205197894 390270 0 0 0 0 415541 636912 20428 90462
390272 390272 0 0 500 0 0 774659 29049 0
1467510560 390278 0 0 9140 0 0 774659 109433 0
1023033792 390290 402638 145927 1513 4863 330477 774659 126120 0
1043240351 390302 0 0 0 0 412000 774659 78895 0
1821020421 390304 0 0 294 52838 496395 774659 131247 0
1780919043 390307 0 0 0 0 403000 651368 65860 0
1659392595 390307 0 0 0 0 403000 651368 65860 0
1427097864 390314 0 0 0 0 300000 711262 71746 0
1124193511 390316 0 0 0 0 300000 663106 67029 0
1811073232 390318 0 0 0 0 293000 722706 71768 0
1427232818 390320 0 0 0 0 284000 774659 78895 0
1043456957 390321 0 0 0 0 284000 722706 71768 0
1336378132 390322 0 0 0 0 284000 774659 78895 0
1528398534 390323 0 0 0 0 278000 707913 72444 0
1265664544 390324 0 0 0 0 271000 774659 78895 0
1578881652 390325 0 0 0 0 271000 655297 66248 0
1962758375 390325 0 0 0 0 271000 655297 66248 0
1497050470 390326 0 0 0 0 271000 722706 71768 0
1760787576 390327 0 0 0 0 407000 655297 66248 0
1225323983 390328 0 0 0 0 268000 707913 72446 0
1104192590 390329 0 0 0 0 268000 774659 78895 0
999993 999993 75972 37367 433 8021 431343 686831 69364 0
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