CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Clovis Community Medical Center
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $37
- Cash Discount Price: $163
- vs. Medicare Baseline: 1.06x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Clovis Community Medical Center is $37. 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 $35.07, this hospital’s rate is 1.06x 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
$37
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: $163 (465%)
Insurance Median: $37 (106%)
Cash: $163 (465% of Medicare)
Ins. Median: $37 (106% 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.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $11 - $130 | 31% |
| Blue Shield | $11 - $408 | 31% |
| Cal Caloptima | $11 | 31% |
| Ccs Fresno | $11 | 31% |
| Ccs Kern | $11 | 31% |
| Ccs Kings | $11 | 31% |
| Ccs Madera/Sacramento | $11 | 31% |
| Ccs Mariposa | $11 | 31% |
| Ccs Merced | $11 | 31% |
| Ccs Stanislaus | $11 | 31% |
| Ccs Tulare | $11 | 31% |
| Chdp | $11 | 31% |
| Fresno County Funded Specialty Care | $11 | 31% |
| Generic Care Out Of County | $11 | 31% |
| Generic Ccs Other Counties | $11 | 31% |
| Genetically Handicapped Person | $11 | 31% |
| Gold Coast Medi-Cal | $11 | 31% |
| Medi-Cal Alameda Alliance For Health | $11 | 31% |
| Medi-Cal Blue Shield Promise Health | $11 | 31% |
| Medi-Cal California Health & Wellness Plan | $11 | 31% |
| Medi-Cal Cencal Health | $11 | 31% |
| Medi-Cal Community Health Group | $11 | 31% |
| Medi-Cal Contra Costa Health Plan | $11 | 31% |
| Medi-Cal Health Plan Of San Mateo | $11 | 31% |
| Medi-Cal Inland Empire Health | $11 | 31% |
| Medi-Cal Kern Family Health | $11 | 31% |
| Medi-Cal La Care Health | $11 | 31% |
| Medi-Cal Molina | $11 | 31% |
| Medi-Cal Partnership Health Plan Of Ca | $11 | 31% |
| San Francisco Health Plan Medi-Cal | $11 | 31% |
| Santa Clara Family Health Plan - Premier Health | $11 | 31% |
| Santa Clara Family Health Plan - Valley Health | $11 | 31% |
| Health Plan Of San Joaquin | $17 | 48% |
| Sante | $17 - $37 | 48% |
| Sequoia Pace | $17 | 48% |
| Adventist -Mcl Calviva Sub Cap | $18 | 51% |
| Healthnet | $21 - $372 | 60% |
| Advantek Table Mountain Rancheria Tribal Member | $37 | 106% |
| Aetna | $37 - $108 | 106% |
| Blue Shield 65 Plus Hmo Ehs | $37 | 106% |
| Blue Shield 65 Plus Hmo First Choice | $37 | 106% |
| Blue Shield Hmo-Cvmp/Medpro | $37 | 106% |
| Blue Shield Promise - Imperial | $37 | 106% |
| Blue Shield Saint Agnes | $37 | 106% |
| Blue Shield Sante | $37 | 106% |
| Brand New Day | $37 | 106% |
| Bscphp - Dhmso | $37 | 106% |
| Bscphp - First Choice | $37 | 106% |
| Bscphp Hmo - First Choice | $37 | 106% |
| Care1St Hmo - Ehs | $37 | 106% |
| Cares Act Provider Relief Fund | $37 | 106% |
| Cigna | $37 - $419 | 106% |
| Gemcare Hmo | $37 | 106% |
| Generic | $37 | 106% |
| Generic Bscphp | $37 | 106% |
| Generic Victims Of Crime | $37 | 106% |
| Hartford Life Supplement | $37 | 106% |
| Healthnet Hmo - Cvmp/Medpro | $37 | 106% |
| Healthnet Hmo - Dhmso | $37 | 106% |
| Healthnet Hmo - La Salle | $37 | 106% |
| Healthnet Hmo - Sante | $37 | 106% |
| Healthnet Sante | $37 | 106% |
| Healthnet Sante - Sub Cap Dual Risk | $37 | 106% |
| Healthnet Sante Dual Risk | $37 | 106% |
| Humana | $37 - $173 | 106% |
| Kaiser | $37 | 106% |
| Medi-Cal Innovative Integrated Health | $37 | 106% |
| Medicare (plans) | $37 | 106% |
| Meritage Blue Shield 65 Plus | $37 | 106% |
| Meritage Brand New Day | $37 | 106% |
| Meritage Healthnet Hmo | $37 | 106% |
| Railroad Part A | $37 | 106% |
| Railroad Part A & B | $37 | 106% |
| Railroad Part B | $37 | 106% |
| Sante Sub Cap Healthnet Seniority | $37 | 106% |
| Sante Sub Cap-Blue Shield/Sante | $37 | 106% |
| Sante-Blue Shield/Sante | $37 | 106% |
| Sante-Healthnet Seniority | $37 | 106% |
| Sante-Sub Cap Ma Brand New Day | $37 | 106% |
| Scan Health Plan | $37 | 106% |
| Sequoia Pace - Peak Tpa | $37 | 106% |
| Todays Pyramid | $37 | 106% |
| UnitedHealthcare | $37 - $377 | 106% |
| Us Marshal | $37 | 106% |
| Victims Of Crime | $37 | 106% |
| Well Path (Cfmg) | $37 - $224 | 106% |
| Wellcare | $37 | 106% |
| Alignment Health Plan | $41 | 117% |
| Champion Health Plan Of California Ma | $41 | 117% |
| Innovative Integrated Health Community Plans Hmo | $41 | 117% |
| Imperial Health Plan Hmo | $43 | 123% |
| Correctcare Integrated Health | $48 | 137% |
| Central Valley Medical Providers | $51 - $143 | 145% |
| Community Care | $52 | 148% |
| Coalinga State Hospital | $74 | 211% |
| Naphcare Inc-Mendota | $80 | 228% |
| Employer 90/40 | $82 | 234% |
| Central Ca Indian Health | $112 | 319% |
| Nx Health Network Ppo | $112 | 319% |
| Healthsmart | $139 - $163 | 396% |
| Coventry Health Care (First Health Network) | $153 | 436% |
| Network By Design | $153 | 436% |
| Generic Multiplan | $173 | 493% |
| Phcs | $173 | 493% |
| Physmetrics Health | $285 | 813% |