CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: The Orthopaedic Hospital of Lutheran Health Networ

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $41
Cash Discount Price: $27
vs. Medicare Baseline: 0.43x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at The Orthopaedic Hospital of Lutheran Health Networ is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.43x the Medicare baseline. Located in 7952 W Jefferson Blvd, Ft Wayne, IN.

Cash / Self-Pay

$27

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $27 (28%)

Insurance Median: $41 (43%)

Cash: $27 (28% of Medicare)

Ins. Median: $41 (43% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Lutheran Preferred	$10 - $63	11%
Php Freedom Network	$11 - $33	12%
Physicians Health Plan	$11 - $41	12%
Cigna	$12 - $105	13%
Aetna	$14 - $51	15%
Three Rivers Preferred	$14 - $47	15%
Sagamore	$17 - $57	18%
Encore Ppo	$18 - $52	19%
Multiplan	$24 - $82	25%
Prime Health Services	$26 - $79	27%
Amish Aid	$27 - $28	28%
First Health	$27 - $81	28%
Self Pay	$27 - $28	28%
Encore	$28 - $84	29%
Bccp	$71	75%
One Call Work Comp	$86	90%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $27.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm The Orthopaedic Hospital of Lutheran Health Networ is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.