CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Essentia Health

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $80
Cash Discount Price: $78
vs. Medicare Baseline: 0.84x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Essentia Health is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.84x the Medicare baseline. Located in 3000 32Nd Ave South, Fargo, ND.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $78 (82%)

Insurance Median: $80 (84%)

Cash: $78 (82% of Medicare)

Ins. Median: $80 (84% 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
Medica Access	$28 - $49	29%
Healthpartners Care Pmap	$40 - $72	42%
Sanford Health Plan	$45 - $83	47%
Blue Cross Blue Shield	$47 - $117	49%
Medica	$58 - $113	61%
Medica Uplan	$58 - $102	61%
Medica Choice	$66 - $117	69%
Ucare	$68 - $121	71%
Cigna	$70 - $123	74%
Healthpartners	$70 - $123	74%
Healthpartners Pcc Prime	$70 - $123	74%
Wea	$75 - $142	79%
America'S Ppo	$81 - $143	85%
UnitedHealthcare	$83 - $147	87%
Wps	$86 - $155	90%
Aetna	$88 - $156	92%

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 $78.
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 Essentia Health 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.