Supplies, drugs & other prices at Lutheran Hospital of Indiana
Fort Wayne, IN · every code in this section with a posted price and a Medicare benchmark.
112 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2019-ncov diagnostic p (U0001) range across 3 matching MRF lines |
$7.50–$39.90 | $25–$133 | varies |
| 2d tee w or w/o fol w/con,in (C8925) | $1,350 | $4,500 | 1.6× |
| 2d tte w or w/o fol w/con,co (C8923) range across 3 matching MRF lines |
$997.50–$1,057.50 | $3,325–$3,525 | varies |
| 2d tte w or w/o fol w/con,fu (C8924) | $840.60 | $2,802 | 2.3× |
| Adm of soc dtr assess 5-15 m (G0136) | $13.20 | $44 | 0.3× |
| Adm tocilizu covid-19 1st (M0249) | $340.80 | $1,136 | 0.7× |
| Adm tocilizu covid-19 2nd (M0250) | $340.80 | $1,136 | 0.7× |
| Admin hepatitis b vaccine (G0010) range across 12 matching MRF lines |
$7.50–$60 | $25–$200 | varies |
| Admin influenza virus vac (G0008) range across 19 matching MRF lines |
$7.50–$47.40 | $25–$158 | varies |
| Admin pneumococcal vaccine (G0009) range across 18 matching MRF lines |
$7.50–$47.40 | $25–$158 | varies |
| Annual alcohol screen 15 min (G0442) range across 4 matching MRF lines |
$6.60–$13.80 | $22–$46 | varies |
| Behavior counsel obesity 15m (G0447) | $18 | $60 | 0.2× |
| Bia whole body composition assessment w/i&r (0358T) | $3.90 | $13 | 0.1× |
| Brief alcohol misuse counsel (G0443) | $18 | $60 | 0.2× |
| Ca screen;flexi sigmoidscope (G0104) range across 5 matching MRF lines |
$73.50–$1,427.34 | $150–$4,757.80 | varies |
| Ca screen;pelvic/breast exam (G0101) range across 4 matching MRF lines |
$14.40–$29.10 | $48–$97 | varies |
| Catheterize for urine spec (P9612) range across 3 matching MRF lines |
$3.60–$3.90 | $12–$13 | varies |
| Colon ca scrn not hi rsk ind (G0121) range across 11 matching MRF lines |
$124.20–$2,132.92 | $414–$7,109.72 | varies |
| Colorectal scrn; hi risk ind (G0105) range across 13 matching MRF lines |
$152.10–$2,099.14 | $507–$6,997.14 | varies |
| Covid-19 lab test non-cdc (U0002) | $37.50 | $125 | 0.7× |
| Crtj Subq Insj Impltbl Glucose Sensor Sys Train (0446T) | $1,295.70 | $4,319 | 0.3× |
| Demonstrate use home inr mon (G0248) | $95.40 | $318 | 0.7× |
| Depression screen annual (G0444) range across 4 matching MRF lines |
$6.60–$13.80 | $22–$46 | varies |
| Diab manage trn per indiv (G0108) range across 3 matching MRF lines |
$36–$63.60 | $120–$212 | varies |
| Diab manage trn ind/group (G0109) range across 4 matching MRF lines |
$11.10–$63.60 | $37–$212 | varies |
| Direct refer hospital observ (G0379) | $636.60 | $2,122 | 1.0× |
| Eia hiv-1/hiv-2 screen (G0432) range across 7 matching MRF lines |
$2.67–$61.80 | $8.89–$206 | varies |
| Ekg tracing for initial prev (G0404) range across 2 matching MRF lines |
$11.10–$11.40 | $37–$38 | varies |
| Elec stim other than wound (G0283) range across 3 matching MRF lines |
$10.80–$86.70 | $36–$289 | varies |
| Elec stim unattend for press (G0281) | $10.80 | $36 | 0.9× |
| Extrnl counterpulse, per tx (G0166) | $115.50 | $385 | 0.8× |
| Fecal blood scrn immunoassay (G0328) range across 9 matching MRF lines |
$16.20–$48.60 | $54–$162 | varies |
| Fecal microbiota prep instil (G0455) | $150 | $500 | 0.2× |
| Hbot, full body chamber, 30m (G0277) | $191.10 | $637 | 1.3× |
| High inten beh couns std 30m (G0445) | $18.30 | $61 | 0.2× |
| Hiv combination assay (G0475) range across 24 matching MRF lines |
$3–$94.20 | $3.23–$314 | varies |
| Home sleep test/type 2 porta (G0398) | $48.60 | $162 | 0.2× |
| Home sleep test/type 3 porta (G0399) range across 2 matching MRF lines |
$48.60–$170.40 | $162–$568 | varies |
| Home sleep test/type 4 porta (G0400) | $48.60 | $162 | 0.2× |
| Hospital outpt clinic visit (G0463) range across 24 matching MRF lines |
$41.70–$1,526.40 | $139–$5,088 | varies |
| Initial preventive exam (G0402) range across 3 matching MRF lines |
$82.80–$127.20 | $276–$424 | varies |
| Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) | $64,526.23 | $215,087.42 | 1.9× |
| Intens behave ther cardio dx (G0446) | $18 | $60 | 0.5× |
| Interro Device Evaluation Cardiac Modulj System (0418T) | $36.30 | $121 | 0.9× |
| Mra w/cont, abd (C8900) | $729.90 | $2,433 | 2.0× |
| Mra w/cont, chest (C8909) | $702.90 | $2,343 | 1.9× |
| Mra w/cont, lwr ext (C8912) | $742.80 | $2,476 | 2.0× |
| Mra w/cont, pelvis (C8918) | $729.90 | $2,433 | 2.0× |
| Mra w/o cont, abd (C8901) range across 4 matching MRF lines |
$705.90–$960.30 | $2,353–$3,201 | varies |
| Mra w/o cont, chest (C8910) | $683.40 | $2,278 | 2.7× |
| Mra w/o cont, lwr ext (C8913) | $1,221 | $4,070 | 4.8× |
| Mra w/o cont, pelvis (C8919) | $705.90 | $2,353 | 2.8× |
| Mra w/o fol w/cont, abd (C8902) | $1,248.90 | $4,163 | 3.4× |
| Mra w/o fol w/cont, chest (C8911) | $1,309.80 | $4,366 | 3.5× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,938 | $6,460 | 5.3× |
| Mra w/o fol w/cont, pelvis (C8920) | $842.10 | $2,807 | 2.3× |
| Mra, w/dye, spinal canal (C8931) | $742.80 | $2,476 | 2.0× |
| Mra, w/dye, upper extremity (C8934) range across 4 matching MRF lines |
$729.90–$742.80 | $2,433–$2,476 | varies |
| Mra, w/o dye, spinal canal (C8932) | $742.80 | $2,476 | 2.9× |
| Mra, w/o dye, upper extr (C8935) range across 4 matching MRF lines |
$705.90–$742.80 | $2,353–$2,476 | varies |
| Mra, w/o&w/dye, spinal canal (C8933) | $742.80 | $2,476 | 2.0× |
| Mra, w/o&w/dye, upper extr (C8936) | $742.80 | $2,476 | 2.0× |
| Mri w/cont, breast, bi (C8906) | $1,993.20 | $6,644 | 5.4× |
| Mri w/cont, breast, uni (C8903) | $673.80 | $2,246 | 3.6× |
| Mri w/o fol w/cont, breast, (C8908) range across 3 matching MRF lines |
$106.94–$960.60 | $356.45–$3,202 | varies |
| Mri w/o fol w/cont, brst, un (C8905) | $881.10 | $2,937 | 2.4× |
| Neuro csf prion prtn qual (0035U) | $811.50 | $2,705 | 1.5× |
| Njx platelet plasma (0232T) | $17.10 | $57 | 0.0× |
| Obtaining screen pap smear (Q0091) range across 8 matching MRF lines |
$13.50–$33.90 | $45–$113 | varies |
| Oth resp proc, group (G0239) | $282.90 | $943 | 7.2× |
| Oth resp proc, indiv (G0238) range across 4 matching MRF lines |
$7.80–$67.50 | $26–$225 | varies |
| Pathogen test for platelets (P9100) | $51.60 | $172 | 0.8× |
| Perc d-e cor revasc chro sin (C9607) | $10,351.80 | $34,506 | 0.5× |
| Perc d-e cor revasc t cabg s (C9604) | $13,847.40 | $46,158 | 1.1× |
| Perc d-e cor stent ather s (C9602) | $13,471.50 | $44,905 | 0.7× |
| Perc drug-el cor stent sing (C9600) | $13,472.40 | $44,908 | 1.1× |
| Perq Sacral Augmt Bilat Inj (0201T) | $4,591.20 | $15,304 | 0.6× |
| Perq Sacral Augmt Unilat Inj (0200T) range across 6 matching MRF lines |
$2,954.10–$3,131.40 | $9,847–$10,438 | varies |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) | $8,938.80 | $29,796 | 0.7× |
| Ppps, initial visit (G0438) range across 3 matching MRF lines |
$105.60–$131.10 | $352–$437 | varies |
| Ppps, subseq visit (G0439) range across 4 matching MRF lines |
$70.50–$88.50 | $235–$295 | varies |
| Prgrmg Device Evaluation Cardiac Modulj System (0417T) | $29.70 | $99 | 0.8× |
| Prolonged iv inf, req pump (C8957) | $1,260 | $4,200 | 5.6× |
| Prostate biopsy, any mthd (G0416) | $255 | $850 | 0.7× |
| Provide inr test mater/equip (G0249) | $84.30 | $281 | 0.6× |
| Psa screening (G0103) range across 10 matching MRF lines |
$1.35–$72 | $4.50–$240 | varies |
| Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision (0447T) | $72.90 | $243 | 0.3× |
| Revasc intra lithotrip-ather (C9766) range across 3 matching MRF lines |
$14,263.80–$15,119.70 | $47,546–$50,399 | varies |
| Revasc intra lithotrip-stent (C9765) range across 5 matching MRF lines |
$14,263.80–$15,119.70 | $47,546–$50,399 | varies |
| Revasc intravasc lithotripsy (C9764) range across 8 matching MRF lines |
$7,040.10–$7,462.50 | $23,467–$24,875 | varies |
| Revasc lith-sten-ath tib/per (C9775) | $22,979.70 | $76,599 | 1.2× |
| Revasc lithotr-ather tib/per (C9774) range across 6 matching MRF lines |
$21,678.90–$22,979.70 | $72,263–$76,599 | varies |
| Revasc lithotr-stent tib/per (C9773) | $22,980 | $76,600 | 1.2× |
| Revasc lithotrip tibi/perone (C9772) range across 5 matching MRF lines |
$13,553.10–$14,366.40 | $45,177–$47,888 | varies |
| Revasc lithotrip-stent-ather (C9767) range across 5 matching MRF lines |
$21,678.90–$22,979.70 | $72,263–$76,599 | varies |
| Rmvl insj impltbl gluc sensor dif anatomic site (0448T) range across 2 matching MRF lines |
$96.90–$1,303.80 | $323–$4,346 | varies |
| Scr c/v cyto,thinlayer,rescr (G0145) | $70.50 | $235 | 2.7× |
| Screen cerv/vag thin layer (G0123) | $90.90 | $303 | 4.5× |
| Screen pap by tech w md supv (P3000) | $10.80 | $36 | 0.6× |
| Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) | $55,979.91 | $186,599.71 | 2.7× |
| Therapeutic procd strg endur (G0237) range across 2 matching MRF lines |
$7.80–$66.90 | $26–$223 | varies |
| Tomosynthesis, mammo (G0279) range across 11 matching MRF lines |
$7.60–$31.80 | $25.32–$106 | varies |
| Trauma respons w/hosp criti (G0390) range across 7 matching MRF lines |
$1,114.20–$4,342.50 | $3,714–$14,475 | varies |
| Trim nail(s) (G0127) range across 2 matching MRF lines |
$6.30–$17.40 | $21–$58 | varies |
| Trluml Perip Athrc Brchiocph (0237T) likely a partial charge, not the full procedure |
$355.80 | $1,186 | 0.0× |
| Trluml Perip Athrc Iliac Art (0238T) range across 5 matching MRF lines |
$2,025–$64,460.88 | $6,750–$214,869.60 | varies |
| Tte w or w/o fol w/con,stres (C8928) | $1,476.60 | $4,922 | 1.8× |
| Tte w or w/o fol w/cont, com (C8921) | $1,390.80 | $4,636 | 1.7× |
| Tte w or wo fol wcon,doppler (C8929) range across 4 matching MRF lines |
$215–$1,790.70 | $716.66–$5,969 | varies |
| Unsched dialysis esrd pt hos (G0257) | $1,066.80 | $3,556 | 1.5× |
| Visit to determ ldct elig (G0296) | $15.30 | $51 | 0.1× |
| Wet mounts/ w preparations (Q0111) | $4.50 | $15 | 0.2× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.