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Financial Information


Hospital charges vary from facility to facility for many complex reasons, including each Hospital's unique mix of services and per relationships. The government requires hospitals to maintain a fee schedule, commonly known as the chargemaster, and to publish the chargemaster on their websites. These charges do not reflect what the patients generally pay for the services they receive or represent what the Hospital is paid in most circumstances. The chargemaster should not be used to estimate a patient's actual cost of care or as a meaningful comparison about what hospitals are paid for their services. We encourage all patients - regardless of insurance status - to contact us to obtain a cost estimate, information about our financial assistance programs, or a better understanding of their insurance coverage.

Current Standard Charges

Description CPT4 Code Rate
Psychological Testing 96101 $50
Discharge from Observation 99217 $110
Initial Observation Care Level 1 99218 $150
Initial Observation Care Level 2 99219 $200
Initial Observation Care Level 3 99220 $250
Initial Hospital Care Level 1 99221 $150
Initial Hospital Care Level 2 99222 $200
Initial Hospital Care Level 3 99223 $250
Telepsychiatry Initial Hospital Care 70 minutes 99223 $250
Subsequent Observation Care Level 1 99224 $80
Subsequent Observation Care Level 2 99225 $100
Subsequent Hospital Care Level 1 99231 $80
Telepsychiatry Dictation 99231 $80
Telepsychiatry Non Dictation 99231 $80
Subsequent Hospital Care Level 2 99232 $100
Telepsychiatry Dictation 99232 $100
Telepsychiatry Non Dictation 99232 $100
Subsequent Hospital Care Level 3 99233 $125
Telepsychiatry Dictation 99233 $125
Telepsychiatry Non Dictation 992333 $125
Admission/Discharge Same Day - Low Comp 99234 $150
Admission/Discharge Same Day - Moderate Comp 99235 $200
Admission/Discharge Same Day - High Comp 99236 $300
Discharge Day 30 Minutes 99238 $100
Discharge Day > 30 Minutes 99239 $200
Observation Subsequent Hours G0378 $40
Observation Subsequent Hours 2nd Day G0378 $40
OBSERVATION 1st Hour G0378 $380
Observation from Inpatient NONE $40
Inpatient LOA day NONE $650
Inpatient day NONE $1,300
Inpatient day DETOX NONE $1,300

DRG Average Charges

DRG Description Average Charge
880 Acute adjustment reactions and psycho-social dysfunction $8,419
881 Depressive Neurosis $2,925
882 Neurosis except depressive $4,945
883 Disordered or personality and impulse control $6,084
885 Psychoses $11,500
887 Other mental diagnoses $3,900
894/896 Alcohol/drug abuse or dependence $5,042


We accept all forms of insurance, including the uninsured.

Financial Assistance

Plain Language Summary of Financial Assistance Policy


The Hospital is committed to offering financial assistance to people who have health care needs and are not able to pay for care. You may be able to get financial assistance if you are not insured, underinsured, not eligible for a government program, or do not qualify for governmental assistance (for example, Medicare or Medicaid). The Hospital strives to make sure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. This is a summary of the Hospital's Financial Assistance Policy (FAP).

Availability of Financial Assistance

You may be able to get financial assistance if you do not have insurance, are underinsured, or if it would be a financial hardship to pay in full the expected out of pocket expenses for services at the Hospital.

Eligibility Requirements

Financial assistance is generally determined by total household income based on the Federal Poverty Level (FPL). If you and/or the responsible party's income combined is at or below 250% of the federal poverty guidelines, you may get discounted rates for the care given by the provider. No person eligible for financial assistance under the FAP will be charged more for emergency or other medically necessary care than amounts generally billed to individuals who have insurance covering such care. If you have insurance coverage or assets available to pay for your care, you may not be eligible for financial assistance.

Where to Find Information

There are many ways to find information about the FAP application process or to get free copies of the FAP or FAP application form. To apply for financial assistance, you may: Request the information in writing by mail or by visiting the Social Services Department at 2900 N. River Rd, West Lafayette, IN 47906 Request the information by calling the Social Services Department at 765-464-0400. 

Availability of Translations

The Financial Assistance policy, application form, and the plain language summary can be offered in English and Spanish. The Hospital may help through use of a qualified bilingual interpreter by request. For information about the Hospital's Financial Assistance Program and translation services, please call for a representative at 765-464-0400.

How to Apply

The application process involves filling out the financial assistance form and submitting the form along with the supporting documents to the Hospital for processing. You may also apply in person by visiting the Hospital at the address listed below. Financial assistance applications are to be submitted to the following office: 

River Bend Hospital
2900 N. River Rd
West Lafayette, IN 47906

Financial Assistance Application Financial Assistance Policy Política De Asistencia Financiera

For more information, please call (765) 464-0400.