CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Clovis Community Medical Center
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $99
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.04x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Clovis Community Medical Center is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.04x the Medicare baseline. Located in 2755 Herndon Ave, Clovis, CA.
Cash / Self-Pay
Unavailable
Average discount available for prompt cash payment at this facility.
Insurance Median
$99
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%)
Insurance Median: $99 (104%)
Ins. Median: $99 (104% 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.
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 |
|---|---|---|
| Blue Cross Blue Shield | $82 - $99 | 86% |
| Blue Shield | $82 - $99 | 86% |
| Cal Caloptima | $82 | 86% |
| Ccs Fresno | $82 | 86% |
| Ccs Kern | $82 | 86% |
| Ccs Kings | $82 | 86% |
| Ccs Madera/Sacramento | $82 | 86% |
| Ccs Mariposa | $82 | 86% |
| Ccs Merced | $82 | 86% |
| Ccs Stanislaus | $82 | 86% |
| Ccs Tulare | $82 | 86% |
| Chdp | $82 | 86% |
| Fresno County Funded Specialty Care | $82 | 86% |
| Generic Care Out Of County | $82 | 86% |
| Generic Ccs Other Counties | $82 | 86% |
| Genetically Handicapped Person | $82 | 86% |
| Gold Coast Medi-Cal | $82 | 86% |
| Medi-Cal Alameda Alliance For Health | $82 | 86% |
| Medi-Cal Blue Shield Promise Health | $82 | 86% |
| Medi-Cal California Health & Wellness Plan | $82 | 86% |
| Medi-Cal Cencal Health | $82 | 86% |
| Medi-Cal Community Health Group | $82 | 86% |
| Medi-Cal Contra Costa Health Plan | $82 | 86% |
| Medi-Cal Health Plan Of San Mateo | $82 | 86% |
| Medi-Cal Inland Empire Health | $82 | 86% |
| Medi-Cal Kern Family Health | $82 | 86% |
| Medi-Cal La Care Health | $82 | 86% |
| Medi-Cal Molina | $82 | 86% |
| Medi-Cal Partnership Health Plan Of Ca | $82 | 86% |
| San Francisco Health Plan Medi-Cal | $82 | 86% |
| Santa Clara Family Health Plan - Premier Health | $82 | 86% |
| Santa Clara Family Health Plan - Valley Health | $82 | 86% |
| Advantek Table Mountain Rancheria Tribal Member | $99 | 104% |
| Aetna | $99 - $208 | 104% |
| Blue Shield 65 Plus Hmo Ehs | $99 | 104% |
| Blue Shield 65 Plus Hmo First Choice | $99 | 104% |
| Blue Shield Hmo-Cvmp/Medpro | $99 | 104% |
| Blue Shield Promise - Imperial | $99 | 104% |
| Blue Shield Saint Agnes | $99 | 104% |
| Blue Shield Sante | $99 | 104% |
| Brand New Day | $99 | 104% |
| Bscphp - Dhmso | $99 | 104% |
| Bscphp - First Choice | $99 | 104% |
| Bscphp Hmo - First Choice | $99 | 104% |
| Care1St Hmo - Ehs | $99 | 104% |
| Cares Act Provider Relief Fund | $99 | 104% |
| Cigna | $99 | 104% |
| Gemcare Hmo | $99 | 104% |
| Generic | $99 | 104% |
| Generic Bscphp | $99 | 104% |
| Generic Victims Of Crime | $99 | 104% |
| Hartford Life Supplement | $99 | 104% |
| Healthnet Hmo - Cvmp/Medpro | $99 | 104% |
| Healthnet Hmo - Dhmso | $99 | 104% |
| Healthnet Hmo - La Salle | $99 | 104% |
| Healthnet Hmo - Sante | $99 | 104% |
| Healthnet Sante | $99 | 104% |
| Healthnet Sante - Sub Cap Dual Risk | $99 | 104% |
| Healthnet Sante Dual Risk | $99 | 104% |
| Humana | $99 | 104% |
| Kaiser | $99 | 104% |
| Medi-Cal Innovative Integrated Health | $99 | 104% |
| Medicare (plans) | $99 | 104% |
| Meritage Blue Shield 65 Plus | $99 | 104% |
| Meritage Brand New Day | $99 | 104% |
| Meritage Healthnet Hmo | $99 | 104% |
| Railroad Part A | $99 | 104% |
| Railroad Part A & B | $99 | 104% |
| Railroad Part B | $99 | 104% |
| Sante | $99 - $127 | 104% |
| Sante Sub Cap Healthnet Seniority | $99 | 104% |
| Sante Sub Cap-Blue Shield/Sante | $99 | 104% |
| Sante-Blue Shield/Sante | $99 | 104% |
| Sante-Healthnet Seniority | $99 | 104% |
| Sante-Sub Cap Ma Brand New Day | $99 | 104% |
| Scan Health Plan | $99 | 104% |
| Sequoia Pace - Peak Tpa | $99 | 104% |
| Todays Pyramid | $99 | 104% |
| UnitedHealthcare | $99 - $101 | 104% |
| Us Marshal | $99 | 104% |
| Victims Of Crime | $99 | 104% |
| Well Path (Cfmg) | $99 | 104% |
| Wellcare | $99 | 104% |
| Alignment Health Plan | $109 | 115% |
| Champion Health Plan Of California Ma | $109 | 115% |
| Innovative Integrated Health Community Plans Hmo | $109 | 115% |
| Imperial Health Plan Hmo | $114 | 120% |
| Health Plan Of San Joaquin | $123 | 129% |
| Sequoia Pace | $123 | 129% |
| Correctcare Integrated Health | $129 | 136% |
| Adventist -Mcl Calviva Sub Cap | $135 | 142% |
| Healthnet | $158 | 166% |
| Coalinga State Hospital | $198 | 208% |
| Naphcare Inc-Mendota | $213 | 224% |