CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: M Health Fairview Southdale Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $115
Cash Discount Price: $72
vs. Medicare Baseline: 3.28x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at M Health Fairview Southdale Hospital is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.28x the Medicare baseline. Located in 6401 France Avenue South, Edina, MN.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $72 (205%)

Insurance Median: $115 (328%)

Cash: $72 (205% of Medicare)

Ins. Median: $115 (328% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 328% of the Medicare baseline (a markup of 228%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Itasca Medical Care	$26 - $34	74%
Primewest	$26 - $34	74%
South Country Health Alliance	$26 - $34	74%
Hennepin Health	$28 - $31	80%
Medica	$28 - $123	80%
Ucare	$28 - $95	80%
Health Partners	$29 - $222	83%
Blue Cross Blue Shield	$30 - $186	86%
Sanford Health Plan	$34 - $113	97%
Security Health Plan	$34 - $144	97%
UnitedHealthcare	$34 - $119	97%
Wellcare	$34	97%
America'S Ppo	$92 - $138	262%
First Health	$145 - $157	413%
Multiplan	$150 - $163	428%
Private Healthcare Systems	$150 - $163	428%
Wisconsin Physician Services	$159 - $173	453%

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 $72.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm M Health Fairview Southdale Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97530.
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.