Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

North Shore Rehabilitation Hospital

Lacombe, LA · CCN 713025 · Rates published

100 distinct procedures filed
12 distinct payers
2,569 rate rows
2026-09-21 last MRF observed
Data quality

1,815 of 2,569 rate rows are consumer-grade (70.7%)

754 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
per-diem day rate — not a per-procedure price 754
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://resources.selectmedical.com/Pricing-Transparency/inpatient-rehabilitation/83-1728077_Northshore_Rehabilitation_Hospital_standardcharges.csv
Found on page https://www.northshore-rehab.com/patients-and-caregivers/admissions/price-transparency/
Discovered viaDiscovered by HANK
Last fetch success · 2026-09-21
Content fingerprint d83248b9d2f2e304… · 23,412,714 bytes · first seen 2026-09-21

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
305
OTHER 		Non-traumatic Brain Injury M <42.50 And A <78.50.,comorbidity In Tier 1 10 $1,625.00 $29,573.16 $1,625.00 nat. median
$2,374
0.7× median
401
OTHER 		Traumatic Spinal Cord Injury With Motor >48.45.,comorbidity In Tier 1 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,154
0.8× median
402
OTHER 		Traumatic Spinal Cord Injury With Motor >30.35 & Motor <48.45.,comorbidity In Ti… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,134
0.8× median
403
OTHER 		Traumatic Spinal Cord Injury With Motor >16.05 & Motor <30.35.,comorbidity In Ti… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,154
0.8× median
404
OTHER 		Traumatic Spinal Cord Injury With Motor <16.05 & Age >63.5.,comorbidity In Tier… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,134
0.8× median
201
OTHER 		Traumatic Brain Injury With Motor >53.35 & Cognitive >23.5.,comorbidity In Tier… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,186
0.7× median
202
OTHER 		Traumatic Brain Injury With Motor >44.25 & Motor <53.35 & Cognitive >23.5.,comor… 10 $1,625.00 $17,668.33 $1,625.00 nat. median
$2,374
0.7× median
203
OTHER 		Traumatic Brain Injury With Motor >44.25 & Cognitive <23.5.,comorbidity In Tier… 10 $1,625.00 $20,224.19 $1,625.00 nat. median
$2,374
0.7× median
204
OTHER 		Traumatic Brain Injury With Motor >40.65 & Motor <44.25.,comorbidity In Tier 1 10 $1,625.00 $35,297.34 $1,625.00 nat. median
$2,374
0.7× median
205
OTHER 		Traumatic Brain Injury With Motor >28.75 & Motor <40.65.,comorbidity In Tier 1 10 $1,625.00 $95,543.13 $1,625.00 nat. median
$2,374
0.7× median
405
OTHER 		Traumatic Spinal Cord Injury With Motor <16.05 & Age <63.5.,comorbidity In Tier… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,154
0.8× median
406
OTHER 		Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50.,comorbidity I… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,154
0.8× median
407
OTHER 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50.,comorbidity In Tier 1 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,154
0.8× median
1801
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury With Motor >40.85.,comorb… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,186
0.7× median
501
OTHER 		Non-traumatic Spinal Cord Injury With Motor >51.35.,comorbidity In Tier 1 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,374
0.7× median
502
OTHER 		Non-traumatic Spinal Cord Injury With Motor >40.15 & Motor <51.35.,comorbidity I… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,374
0.7× median
503
OTHER 		Non-traumatic Spinal Cord Injury With Motor >31.25 & Motor <40.15.,comorbidity I… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,374
0.7× median
504
OTHER 		Non-traumatic Spinal Cord Injury With Motor >29.25 & Motor <31.25.,comorbidity I… 10 $1,625.00 $31,694.72 $1,625.00 nat. median
$2,374
0.7× median
505
OTHER 		Non-traumatic Spinal Cord Injury With Motor >23.75 & Motor <29.25.,comorbidity I… 10 $1,625.00 $74,782.09 $1,625.00 nat. median
$2,374
0.7× median
1802
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury With Motor >23.05 & Motor… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,186
0.7× median
1803
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury With Motor <23.05.,comorb… 10 $1,625.00 $21,693.41 $1,625.00 nat. median
$2,186
0.7× median
1804
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury With Motor Score From 12… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,186
0.7× median
1805
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50.,c… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,186
0.7× median
1806
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50.,comorbidity In… 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,186
0.7× median
301
OTHER 		Non-traumatic Brain Injury With Motor >41.05.,comorbidity In Tier 1 10 $1,625.00 $1,625.00 $1,625.00 nat. median
$2,374
0.7× median
302
OTHER 		Non-traumatic Brain Injury With Motor >35.05 & Motor <41.05.,comorbidity In Tier… 10 $1,625.00 $17,714.13 $1,625.00 nat. median
$2,374
0.7× median
303
OTHER 		Non-traumatic Brain Injury With Motor >26.15 & Motor <35.05.,comorbidity In Tier… 10 $1,625.00 $23,162.62 $1,625.00 nat. median
$2,374
0.7× median
304
OTHER 		Non-traumatic Brain Injury With Motor <26.15.,comorbidity In Tier 1 10 $1,625.00 $27,739.00 $1,625.00 nat. median
$2,374
0.7× median
1001
OTHER 		Amputation, Lower Extremity With Motor >47.65.,comorbidity In Tier 1 10 $1,436.00 $1,436.00 $1,436.00 nat. median
$2,154
0.7× median
103
OTHER 		Stroke With Motor >44.45 & Motor <51.05 & Cognitive <18.5.,comorbidity In Tier 1 10 $1,436.00 $31,967.49 $1,436.00 nat. median
$2,886
outlier · 0.5×
104
OTHER 		Stroke With Motor >38.85 & Motor <44.45.,comorbidity In Tier 1 10 $1,436.00 $31,993.47 $1,436.00 nat. median
$2,374
0.6× median
105
OTHER 		Stroke With Motor >34.25 & Motor <38.85.,comorbidity In Tier 1 10 $1,436.00 $42,638.34 $1,436.00 nat. median
$2,374
0.6× median
106
OTHER 		Stroke With Motor >30.05 & Motor <34.25.,comorbidity In Tier 1 10 $1,436.00 $52,502.17 $1,436.00 nat. median
$2,886
outlier · 0.5×
1101
OTHER 		Amputation, Other Extremity With Motor >36.35.,comorbidity In Tier 1 10 $1,436.00 $1,436.00 $1,436.00 nat. median
$2,154
0.7× median
1102
OTHER 		Amputation, Other Extremity With Motor <36.35.,comorbidity In Tier 1 10 $1,436.00 $1,436.00 $1,436.00 nat. median
$2,374
0.6× median
1103
OTHER 		Lower-lower Extremity With Motor Score From 12 �37.,comorbidity In Tier 1 10 $1,436.00 $1,436.00 $1,436.00 nat. median
$2,154
0.7× median
1003
OTHER 		Amputation, Lower Extremity With Motor <36.25.,comorbidity In Tier 1 10 $1,436.00 $1,436.00 $1,436.00 nat. median
$2,154
0.7× median
1002
OTHER 		Amputation, Lower Extremity With Motor >36.25 & Motor <47.65.,comorbidity In Tie… 10 $1,436.00 $1,436.00 $1,436.00 nat. median
$2,154
0.7× median
101
OTHER 		Stroke With Motor >51.05.,comorbidity In Tier 1 10 $1,436.00 $1,436.00 $1,436.00 nat. median
$2,374
0.6× median
102
OTHER 		Stroke With Motor >44.45 & Motor <51.05 & Cognitive >18.5.,comorbidity In Tier 1 10 $1,436.00 $15,395.82 $1,436.00 nat. median
$2,374
0.6× median
5101
OTHER 		Expired, Orthopedic, Length Of Stay Is 13 Days Or Fewer. 10 $1,250.00 $1,250.00 $1,250.00 nat. median
$473
outlier · 2.6×
5102
OTHER 		Expired, Orthopedic, Length Of Stay Is 14 Days Or More. 10 $1,250.00 $1,250.00 $1,250.00 nat. median
$1,059
1.2× median
5103
OTHER 		Expired, Not Orthopedic, Length Of Stay Is 15 Days Or Fewer. 10 $1,250.00 $1,250.00 $1,250.00 nat. median
$2,154
0.6× median
5104
OTHER 		Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More. 10 $1,250.00 $1,250.00 $1,250.00 nat. median
$2,154
0.6× median
601
OTHER 		Neurological With Motor >47.75.,comorbidity In Tier 1 10 $1,250.00 $14,173.14 $1,250.00 nat. median
$2,190
0.6× median
602
OTHER 		Neurological With Motor >37.35 & Motor <47.75.,comorbidity In Tier 1 10 $1,250.00 $13,646.24 $1,250.00 nat. median
$2,374
0.5× median
603
OTHER 		Neurological With Motor >25.85 & Motor <37.35.,comorbidity In Tier 1 10 $1,250.00 $23,411.53 $1,250.00 nat. median
$2,374
0.5× median
604
OTHER 		Neurological With Motor <25.85.,comorbidity In Tier 1 10 $1,250.00 $26,853.81 $1,250.00 nat. median
$2,374
0.5× median
701
OTHER 		Fracture Of Lower Extremity With Motor >42.15.,comorbidity In Tier 1 10 $1,250.00 $13,494.39 $1,250.00 nat. median
$3,015
outlier · 0.4×
702
OTHER 		Fracture Of Lower Extremity With Motor >34.15 & Motor <42.15.,comorbidity In Tie… 10 $1,250.00 $1,250.00 $1,250.00 nat. median
$1,500
0.8× median

Other procedures at this hospital

Browse this hospital's 100 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
305 OTHER Non-traumatic Brain Injury M <42.50 And A <78.50.,comorbidity In Tier 1 21 10 — — $1,625.00 $29,573.16 $1,625.00 2026-09-21
401 OTHER Traumatic Spinal Cord Injury With Motor >48.45.,comorbidity In Tier 1 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
402 OTHER Traumatic Spinal Cord Injury With Motor >30.35 & Motor <48.45.,comorbidity In Ti… 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
403 OTHER Traumatic Spinal Cord Injury With Motor >16.05 & Motor <30.35.,comorbidity In Ti… 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
404 OTHER Traumatic Spinal Cord Injury With Motor <16.05 & Age >63.5.,comorbidity In Tier … 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
201 OTHER Traumatic Brain Injury With Motor >53.35 & Cognitive >23.5.,comorbidity In Tier … 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
202 OTHER Traumatic Brain Injury With Motor >44.25 & Motor <53.35 & Cognitive >23.5.,comor… 19 10 — — $1,625.00 $17,668.33 $1,625.00 2026-09-21
203 OTHER Traumatic Brain Injury With Motor >44.25 & Cognitive <23.5.,comorbidity In Tier … 18 10 — — $1,625.00 $20,224.19 $1,625.00 2026-09-21
204 OTHER Traumatic Brain Injury With Motor >40.65 & Motor <44.25.,comorbidity In Tier 1 21 10 — — $1,625.00 $35,297.34 $1,625.00 2026-09-21
205 OTHER Traumatic Brain Injury With Motor >28.75 & Motor <40.65.,comorbidity In Tier 1 19 10 — — $1,625.00 $95,543.13 $1,625.00 2026-09-21
405 OTHER Traumatic Spinal Cord Injury With Motor <16.05 & Age <63.5.,comorbidity In Tier … 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
406 OTHER Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50.,comorbidity I… 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
407 OTHER Traumatic Spinal Cord Injury M <24.50 And A >=61.50.,comorbidity In Tier 1 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
1801 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury With Motor >40.85.,comorb… 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
501 OTHER Non-traumatic Spinal Cord Injury With Motor >51.35.,comorbidity In Tier 1 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
502 OTHER Non-traumatic Spinal Cord Injury With Motor >40.15 & Motor <51.35.,comorbidity I… 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
503 OTHER Non-traumatic Spinal Cord Injury With Motor >31.25 & Motor <40.15.,comorbidity I… 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
504 OTHER Non-traumatic Spinal Cord Injury With Motor >29.25 & Motor <31.25.,comorbidity I… 21 10 — — $1,625.00 $31,694.72 $1,625.00 2026-09-21
505 OTHER Non-traumatic Spinal Cord Injury With Motor >23.75 & Motor <29.25.,comorbidity I… 20 10 — — $1,625.00 $74,782.09 $1,625.00 2026-09-21
1802 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury With Motor >23.05 & Motor… 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
1803 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury With Motor <23.05.,comorb… 18 10 — — $1,625.00 $21,693.41 $1,625.00 2026-09-21
1804 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury With Motor Score From 12 … 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
1805 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50.,c… 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
1806 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50.,comorbidity In … 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
301 OTHER Non-traumatic Brain Injury With Motor >41.05.,comorbidity In Tier 1 17 10 — — $1,625.00 $1,625.00 $1,625.00 2026-09-21
302 OTHER Non-traumatic Brain Injury With Motor >35.05 & Motor <41.05.,comorbidity In Tier… 19 10 — — $1,625.00 $17,714.13 $1,625.00 2026-09-21
303 OTHER Non-traumatic Brain Injury With Motor >26.15 & Motor <35.05.,comorbidity In Tier… 18 10 — — $1,625.00 $23,162.62 $1,625.00 2026-09-21
304 OTHER Non-traumatic Brain Injury With Motor <26.15.,comorbidity In Tier 1 19 10 — — $1,625.00 $27,739.00 $1,625.00 2026-09-21
1001 OTHER Amputation, Lower Extremity With Motor >47.65.,comorbidity In Tier 1 17 10 — — $1,436.00 $1,436.00 $1,436.00 2026-09-21
103 OTHER Stroke With Motor >44.45 & Motor <51.05 & Cognitive <18.5.,comorbidity In Tier 1 23 10 — — $1,436.00 $31,967.49 $1,436.00 2026-09-21
104 OTHER Stroke With Motor >38.85 & Motor <44.45.,comorbidity In Tier 1 27 10 — — $1,436.00 $31,993.47 $1,436.00 2026-09-21
105 OTHER Stroke With Motor >34.25 & Motor <38.85.,comorbidity In Tier 1 21 10 — — $1,436.00 $42,638.34 $1,436.00 2026-09-21
106 OTHER Stroke With Motor >30.05 & Motor <34.25.,comorbidity In Tier 1 29 10 — — $1,436.00 $52,502.17 $1,436.00 2026-09-21
1101 OTHER Amputation, Other Extremity With Motor >36.35.,comorbidity In Tier 1 17 10 — — $1,436.00 $1,436.00 $1,436.00 2026-09-21
1102 OTHER Amputation, Other Extremity With Motor <36.35.,comorbidity In Tier 1 17 10 — — $1,436.00 $1,436.00 $1,436.00 2026-09-21
1103 OTHER Lower-lower Extremity With Motor Score From 12 �37.,comorbidity In Tier 1 17 10 — — $1,436.00 $1,436.00 $1,436.00 2026-09-21
1003 OTHER Amputation, Lower Extremity With Motor <36.25.,comorbidity In Tier 1 17 10 — — $1,436.00 $1,436.00 $1,436.00 2026-09-21
1002 OTHER Amputation, Lower Extremity With Motor >36.25 & Motor <47.65.,comorbidity In Tie… 17 10 — — $1,436.00 $1,436.00 $1,436.00 2026-09-21
101 OTHER Stroke With Motor >51.05.,comorbidity In Tier 1 17 10 — — $1,436.00 $1,436.00 $1,436.00 2026-09-21
102 OTHER Stroke With Motor >44.45 & Motor <51.05 & Cognitive >18.5.,comorbidity In Tier 1 21 10 — — $1,436.00 $15,395.82 $1,436.00 2026-09-21
5101 OTHER Expired, Orthopedic, Length Of Stay Is 13 Days Or Fewer. 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
5102 OTHER Expired, Orthopedic, Length Of Stay Is 14 Days Or More. 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
5103 OTHER Expired, Not Orthopedic, Length Of Stay Is 15 Days Or Fewer. 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
5104 OTHER Expired, Not Orthopedic, Length Of Stay Is 16 Days Or More. 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
601 OTHER Neurological With Motor >47.75.,comorbidity In Tier 1 18 10 — — $1,250.00 $14,173.14 $1,250.00 2026-09-21
602 OTHER Neurological With Motor >37.35 & Motor <47.75.,comorbidity In Tier 1 18 10 — — $1,250.00 $13,646.24 $1,250.00 2026-09-21
603 OTHER Neurological With Motor >25.85 & Motor <37.35.,comorbidity In Tier 1 18 10 — — $1,250.00 $23,411.53 $1,250.00 2026-09-21
604 OTHER Neurological With Motor <25.85.,comorbidity In Tier 1 21 10 — — $1,250.00 $26,853.81 $1,250.00 2026-09-21
701 OTHER Fracture Of Lower Extremity With Motor >42.15.,comorbidity In Tier 1 19 10 — — $1,250.00 $13,494.39 $1,250.00 2026-09-21
702 OTHER Fracture Of Lower Extremity With Motor >34.15 & Motor <42.15.,comorbidity In Tie… 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
703 OTHER Fracture Of Lower Extremity With Motor >28.15 & Motor <34.15.,comorbidity In Tie… 22 10 — — $1,250.00 $24,177.96 $1,250.00 2026-09-21
704 OTHER Fracture Of Lower Extremity With Motor <28.15.,comorbidity In Tier 1 21 10 — — $1,250.00 $34,086.83 $1,250.00 2026-09-21
801 OTHER Replacement Of Lower Extremity Joint With Motor >49.55.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
802 OTHER Replacement Of Lower Extremity Joint With Motor >37.05 & Motor <49.55.,comorbidi… 18 10 — — $1,250.00 $3,411.56 $1,250.00 2026-09-21
803 OTHER Replacement Of Lower Extremity Joint With Motor >28.65 & Motor <37.05 & Age >83.… 18 10 — — $1,250.00 $16,560.99 $1,250.00 2026-09-21
804 OTHER Replacement Of Lower Extremity Joint With Motor >28.65 & Motor <37.05 & Age <83.… 18 10 — — $1,250.00 $21,243.85 $1,250.00 2026-09-21
805 OTHER Replacement Of Lower Extremity Joint With Motor >22.05 & Motor <28.65.,comorbidi… 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
901 OTHER Other Orthopedic With Motor >44.75.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
902 OTHER Other Orthopedic With Motor >34.35 & Motor <44.75.,comorbidity In Tier 1 18 10 — — $1,250.00 $16,391.79 $1,250.00 2026-09-21
903 OTHER Other Orthopedic With Motor >24.15 & Motor <34.35.,comorbidity In Tier 1 19 10 — — $1,250.00 $22,547.02 $1,250.00 2026-09-21
904 OTHER Other Orthopedic With Motor <24.15.,comorbidity In Tier 1 22 10 — — $1,250.00 $27,850.04 $1,250.00 2026-09-21
1004 OTHER Amputation, Lower Extremity With Motor Score From 39 �45.,comorbidity In Tier 1 19 10 — — $1,250.00 $44,191.54 $1,250.00 2026-09-21
1201 OTHER Osteoarthritis With Motor >37.65.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1202 OTHER Osteoarthritis With Motor >30.75 & Motor <37.65.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1203 OTHER Osteoarthritis With Motor <30.75.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1204 OTHER Osteoarthritis With Motor Score From 39 �47.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1301 OTHER Rheumatoid, Other Arthritis With Motor >36.35.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1302 OTHER Rheumatoid, Other Arthritis With Motor >26.15 & Motor <36.35.,comorbidity In Tie… 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1303 OTHER Rheumatoid, Other Arthritis With Motor <26.15.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1304 OTHER Rheumatoid, Other Arthritis With Motor Score From 12 �35.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1305 OTHER Rheumatoid Other Arthritis M <51.50 And A <64.50.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1401 OTHER Cardiac With Motor >48.85.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1402 OTHER Cardiac With Motor >38.55 & Motor <48.85.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1403 OTHER Cardiac With Motor >31.15 & Motor <38.55.,comorbidity In Tier 1 20 10 — — $1,250.00 $23,753.65 $1,250.00 2026-09-21
1404 OTHER Cardiac With Motor <31.15.,comorbidity In Tier 1 19 10 — — $1,250.00 $27,358.52 $1,250.00 2026-09-21
1501 OTHER Pulmonary With Motor >49.25.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1502 OTHER Pulmonary With Motor >39.05 & Motor <49.25.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1503 OTHER Pulmonary With Motor >29.15 & Motor <39.05.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1504 OTHER Pulmonary With Motor <29.15.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1601 OTHER Pain Syndrome With Motor >37.15.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1602 OTHER Pain Syndrome With Motor >26.75 & Motor <37.15.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1603 OTHER Pain Syndrome With Motor <26.75.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1604 OTHER Pain Syndrome M <43.50.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1701 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury With Motor >39.25.,com… 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1702 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury With Motor >31.05 & Mo… 18 10 — — $1,250.00 $18,266.81 $1,250.00 2026-09-21
1703 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury With Motor >25.55 & Mo… 18 10 — — $1,250.00 $11,940.46 $1,250.00 2026-09-21
1704 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury With Motor <25.55.,com… 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1705 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50.,comorbidity … 20 10 — — $1,250.00 $33,213.89 $1,250.00 2026-09-21
1901 OTHER Guillian Barre With Motor >35.95.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1902 OTHER Guillian Barre With Motor >18.05 & Motor <35.95.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1903 OTHER Guillian Barre With Motor <18.05.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
1904 OTHER Guillain-barre M <38.50.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
2001 OTHER Miscellaneous With Motor >49.15.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
2002 OTHER Miscellaneous With Motor >38.75 & Motor <49.15.,comorbidity In Tier 1 21 10 — — $1,250.00 $26,354.79 $1,250.00 2026-09-21
2003 OTHER Miscellaneous With Motor >27.85 & Motor <38.75.,comorbidity In Tier 1 20 10 — — $1,250.00 $21,667.86 $1,250.00 2026-09-21
2004 OTHER Miscellaneous With Motor <27.85, Comorbidity In Tier 1 19 10 — — $1,250.00 $34,483.18 $1,250.00 2026-09-21
2005 OTHER Miscellaneous With Motor Score From 12 �32 And Patient Is 81 Years Old Or Younge… 20 10 — — $1,250.00 $28,086.44 $1,250.00 2026-09-21
2101 OTHER Burns With Motor >0.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
2102 OTHER Burns With Motor Score From 12 �45.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
5001 OTHER Short-stay Cases, Length Of Stay Is 3 Days Or Fewer.,comorbidity In Tier 1 17 10 — — $1,250.00 $1,250.00 $1,250.00 2026-09-21
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