CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Essentia Health

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $97
  • Cash Discount Price: $110
  • vs. Medicare Baseline: 0.72x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Essentia Health is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $110. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.72x the Medicare baseline. Located in 3000 32Nd Ave South, Fargo, ND.
Cash / Self-Pay
$110

Average discount available for prompt cash payment at this facility.

Insurance Median
$97

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $110 (81%)
Insurance Median: $97 (72%)
Cash: $110 (81% of Medicare)
Ins. Median: $97 (72% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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.

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 $39 29%
Healthpartners Care Pmap $57 42%
Sanford Health Plan $63 - $66 46%
Blue Cross Blue Shield $66 - $173 49%
Medica $81 - $91 60%
Medica Uplan $81 60%
Medica Choice $93 69%
Ucare $97 72%
Cigna $98 72%
Healthpartners $98 72%
Healthpartners Pcc Prime $98 72%
Wea $106 - $113 78%
America'S Ppo $114 84%
UnitedHealthcare $117 86%
Wps $122 - $123 90%
Aetna $125 92%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3000 32Nd Ave South, Fargo, ND 58104
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals