Culture, blood
Facility: The Orthopaedic Hospital of Lutheran Health Networ
Billing Code: 87040 (CPT)
- CPT Billing Code: 87040
- Insurance Median: $21
- Cash Discount Price: $134
- vs. Medicare Baseline: 2.03x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $10.32 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 203% of the Medicare baseline (a markup of 103%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $5 - $17 | 48% |
| UnitedHealthcare | $9 - $246 | 87% |
| Aetna | $10 - $242 | 97% |
| Caresource | $10 | 97% |
| Department Of Veterans Affairs | $10 | 97% |
| Humana | $10 | 97% |
| Iu Health Plan | $10 | 97% |
| Managed Health Services | $10 - $21 | 97% |
| Medicaid / KanCare | $10 | 97% |
| Medicare (plans) | $10 | 97% |
| Mhs | $10 | 97% |
| Node Devoted Health Mcr Adv | $10 | 97% |
| Node Hospice Non Par Agree | $10 | 97% |
| Node Mhs Mcr Adv | $10 | 97% |
| Node Va | $10 | 97% |
| One Call Work Comp | $10 | 97% |
| Small Business Aid | $10 | 97% |
| Tricare | $10 | 97% |
| In Dept Of Correction | $11 | 107% |
| Node Pphp Mcr Adv | $11 | 107% |
| Police And Sheriff | $11 | 107% |
| Node Us Dept Of Labor | $13 | 126% |
| Lutheran Advanced Network | $15 | 145% |
| Lutheran Preferred | $15 - $299 | 145% |
| Node Lutheran Three Rivers Preferred Plus 150 | $15 | 145% |
| Occunet In Work Comp | $15 | 145% |
| Align Network | $17 | 165% |
| Node Lutheran Three Rivers Preferred Plus 175 | $18 | 174% |
| Encore Wc | $19 | 184% |
| Medrisk In Work Comp | $19 | 184% |
| Php Freedom Network | $19 | 184% |
| Prime Health Services | $19 - $374 | 184% |
| Three Rivers Preferred In Work Comp | $19 | 184% |
| Objective Surgical | $20 | 194% |
| In Work Comp | $21 | 203% |
| Lutheran Network | $21 | 203% |
| Encore Kba Epo | $25 | 242% |
| Physicians Health Plan | $25 - $193 | 242% |
| Encore Kba Ppo | $31 | 300% |
| Amish Aid | $134 | 1298% |
| Self Pay | $134 | 1298% |
| Cigna | $175 - $498 | 1696% |
| Three Rivers Preferred | $199 - $224 | 1928% |
| Sagamore | $240 - $269 | 2326% |
| Encore Ppo | $249 | 2413% |
| Multiplan | $344 - $388 | 3333% |
| First Health | $383 | 3711% |
| Encore | $398 | 3857% |