CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Essentia Health

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $43
Cash Discount Price: $68
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Essentia Health is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.33x the Medicare baseline. Located in 3000 32Nd Ave South, Fargo, ND.

Cash / Self-Pay

$68

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $68 (210%)

Insurance Median: $43 (133%)

Cash: $68 (210% of Medicare)

Ins. Median: $43 (133% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 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
Medica Access	$24	74%
Advocare/Security Health	$32	99%
Blue Cross Blue Shield	$32 - $61	99%
Freedom Blue Ppo	$32	99%
Healthpartners Care Msho / Mcr Adv	$32	99%
Imcare Msho Pcc Prime	$32	99%
Imcare Msho Ref Req	$32	99%
Itasca Med Care	$32	99%
Medica Advantage Solutions	$32	99%
Medica Msho/Dual Solutions	$32	99%
Medica Prime Solution Group	$32	99%
Medicare (plans)	$32	99%
Nd Va Administration	$32	99%
Platinum Blue/Vantage Blue	$32	99%
Primewest Msho	$32	99%
Secure Blue Msho	$32	99%
Ubh Cost Plan	$32	99%
Ubh Msho	$32	99%
Ucare Msho	$32	99%
UnitedHealthcare	$32 - $72	99%
Primewest	$33	102%
Healthpartners Care Pmap	$35	108%
Sanford Health Plan	$39 - $66	120%
Medica	$50 - $55	154%
Medica Uplan	$50	154%
Medica Choice	$57	176%
Ucare	$59	182%
Cigna	$60	185%
Healthpartners	$60	185%
Healthpartners Pcc Prime	$60	185%
Wea	$65 - $69	201%
America'S Ppo	$70	216%
Wps	$75 - $76	231%
Aetna	$76	235%

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 $68.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Essentia Health is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
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.