Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
COLON CA SCRN NOT HI RSK IND
The hospitals that file a Premera rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.
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108 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · fee schedule · outpatient | 1 | $950.10 | $950.10 – $950.10 |
| 2 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · inpatient | 1 | $176.15 | $176.15 – $176.15 |
| 3 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · outpatient | 1 | $176.15 | $176.15 – $176.15 |
| 4 | Coulee Medical Center Grand Coulee, WA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $939.70 | $939.70 – $939.70 |
| 5 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · outpatient | 1 | $950.10 | $950.10 – $950.10 |
| 6 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · inpatient | 1 | $176.15 | $176.15 – $176.15 |
| 7 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · outpatient | 1 | $176.15 | $176.15 – $176.15 |
| 8 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 4 | $3,102 | $1,460 – $4,197 |
| 9 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · outpatient | 1 | $763.00 | $763.00 – $763.00 |
| 10 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · fee schedule · inpatient | 1 | $165.64 | $165.64 – $165.64 |
| 11 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · fee schedule · outpatient | 1 | $160.84 | $160.84 – $160.84 |
| 12 | Mary Bridge Children's Hospital Tacoma, WA fee schedule · outpatient | 4 | $3,102 | $1,460 – $4,197 |
| 13 | Mercy Fitzgerald Hospital Darby, PA facility · fee schedule · outpatient | 1 | $2,991 | $2,991 – $2,991 |
| 14 | Mercy Fitzgerald Hospital Darby, PA professional · fee schedule · inpatient | 1 | $102.31 | $102.31 – $102.31 |
| 15 | Mercy Fitzgerald Hospital Darby, PA professional · fee schedule · outpatient | 1 | $102.31 | $102.31 – $102.31 |
| 16 | Mercy Health Hackley Campus Muskogen, MI facility · fee schedule · outpatient | 1 | $987.88 | $911.89 – $1,140 |
| 17 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · inpatient | 1 | $146.20 | $146.20 – $146.20 |
| 18 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · outpatient | 1 | $146.20 | $146.20 – $146.20 |
| 19 | Mercy Health Saint Marys Rockford, MI facility · fee schedule · outpatient | 1 | $926.31 | $926.31 – $926.31 |
| 20 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · inpatient | 1 | $146.20 | $146.20 – $146.20 |
| 21 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · outpatient | 1 | $146.20 | $146.20 – $146.20 |
| 22 | Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · outpatient | 1 | $950.10 | $950.10 – $950.10 |
| 23 | Mercy Medical Center - Dubuque Dubuque, IA facility · fee schedule · outpatient | 1 | $2.46 | $2.46 – $2.46 |
| 24 | Mercy Medical Center - Dyersville Dyersville, IA facility · fee schedule · outpatient | 1 | $2.79 | $2.79 – $2.79 |
| 25 | Mercy Medical Center - New Hampton New Hampton, IA facility · fee schedule · outpatient | 1 | $2.49 | $2.46 – $2.52 |
← Payers reporting HCPCS G0121 · Snapshot 20261108T203506Z-bb90dbab