CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Clovis Community Medical Center
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $34
- Cash Discount Price: $163
- vs. Medicare Baseline: 1.05x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Clovis Community Medical Center is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $163. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.05x the Medicare baseline. Located in 2755 Herndon Ave, Clovis, CA.
Cash / Self-Pay
$163
Average discount available for prompt cash payment at this facility.
Insurance Median
$34
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: $163 (503%)
Insurance Median: $34 (105%)
Cash: $163 (503% of Medicare)
Ins. Median: $34 (105% 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.
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 |
|---|---|---|
| Advantek Table Mountain Rancheria Tribal Member | $34 | 105% |
| Aetna | $34 - $108 | 105% |
| Blue Cross Blue Shield | $34 - $130 | 105% |
| Blue Shield | $34 - $408 | 105% |
| Blue Shield 65 Plus Hmo Ehs | $34 | 105% |
| Blue Shield 65 Plus Hmo First Choice | $34 | 105% |
| Blue Shield Hmo-Cvmp/Medpro | $34 | 105% |
| Blue Shield Promise - Imperial | $34 | 105% |
| Blue Shield Saint Agnes | $34 | 105% |
| Blue Shield Sante | $34 | 105% |
| Brand New Day | $34 | 105% |
| Bscphp - Dhmso | $34 | 105% |
| Bscphp - First Choice | $34 | 105% |
| Bscphp Hmo - First Choice | $34 | 105% |
| Care1St Hmo - Ehs | $34 | 105% |
| Cares Act Provider Relief Fund | $34 | 105% |
| Cigna | $34 - $419 | 105% |
| Gemcare Hmo | $34 | 105% |
| Generic | $34 | 105% |
| Generic Bscphp | $34 | 105% |
| Generic Victims Of Crime | $34 | 105% |
| Hartford Life Supplement | $34 | 105% |
| Healthnet Hmo - Cvmp/Medpro | $34 | 105% |
| Healthnet Hmo - Dhmso | $34 | 105% |
| Healthnet Hmo - La Salle | $34 | 105% |
| Healthnet Hmo - Sante | $34 | 105% |
| Healthnet Sante | $34 | 105% |
| Healthnet Sante - Sub Cap Dual Risk | $34 | 105% |
| Healthnet Sante Dual Risk | $34 | 105% |
| Humana | $34 - $173 | 105% |
| Kaiser | $34 | 105% |
| Medi-Cal Innovative Integrated Health | $34 | 105% |
| Medicare (plans) | $34 | 105% |
| Meritage Blue Shield 65 Plus | $34 | 105% |
| Meritage Brand New Day | $34 | 105% |
| Meritage Healthnet Hmo | $34 | 105% |
| Railroad Part A | $34 | 105% |
| Railroad Part A & B | $34 | 105% |
| Railroad Part B | $34 | 105% |
| Sante | $34 | 105% |
| Sante Sub Cap Healthnet Seniority | $34 | 105% |
| Sante Sub Cap-Blue Shield/Sante | $34 | 105% |
| Sante-Blue Shield/Sante | $34 | 105% |
| Sante-Healthnet Seniority | $34 | 105% |
| Sante-Sub Cap Ma Brand New Day | $34 | 105% |
| Scan Health Plan | $34 | 105% |
| Sequoia Pace - Peak Tpa | $34 | 105% |
| Todays Pyramid | $34 | 105% |
| UnitedHealthcare | $34 - $377 | 105% |
| Us Marshal | $34 | 105% |
| Victims Of Crime | $34 | 105% |
| Well Path (Cfmg) | $34 - $224 | 105% |
| Wellcare | $34 | 105% |
| Alignment Health Plan | $38 | 117% |
| Champion Health Plan Of California Ma | $38 | 117% |
| Innovative Integrated Health Community Plans Hmo | $38 | 117% |
| Imperial Health Plan Hmo | $39 | 120% |
| Correctcare Integrated Health | $44 | 136% |
| Central Valley Medical Providers | $51 - $143 | 157% |
| Community Care | $52 | 160% |
| Coalinga State Hospital | $68 | 210% |
| Naphcare Inc-Mendota | $73 | 225% |
| Employer 90/40 | $82 | 253% |
| Central Ca Indian Health | $112 | 346% |
| Nx Health Network Ppo | $112 | 346% |
| Healthsmart | $139 - $163 | 429% |
| Coventry Health Care (First Health Network) | $153 | 472% |
| Network By Design | $153 | 472% |
| Generic Multiplan | $173 | 534% |
| Phcs | $173 | 534% |
| Physmetrics Health | $285 | 880% |
| Healthnet | $353 - $372 | 1090% |