CMS Price Transparency Data
Physical therapy (gait training)
Facility: Clovis Community Medical Center
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $30
- Cash Discount Price: $134
- vs. Medicare Baseline: 1.03x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Clovis Community Medical Center is $30. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $134. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.03x the Medicare baseline. Located in 2755 Herndon Ave, Clovis, CA.
Cash / Self-Pay
$134
Average discount available for prompt cash payment at this facility.
Insurance Median
$30
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$29.06
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $29.06 (100%)
Cash / Self-Pay: $134 (461%)
Insurance Median: $30 (103%)
Cash: $134 (461% of Medicare)
Ins. Median: $30 (103% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $29.06 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.
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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 - $107 | 38% |
| Blue Shield | $11 - $408 | 38% |
| Cal Caloptima | $11 | 38% |
| Ccs Fresno | $11 | 38% |
| Ccs Kern | $11 | 38% |
| Ccs Kings | $11 | 38% |
| Ccs Madera/Sacramento | $11 | 38% |
| Ccs Mariposa | $11 | 38% |
| Ccs Merced | $11 | 38% |
| Ccs Stanislaus | $11 | 38% |
| Ccs Tulare | $11 | 38% |
| Chdp | $11 | 38% |
| Fresno County Funded Specialty Care | $11 | 38% |
| Generic Care Out Of County | $11 | 38% |
| Generic Ccs Other Counties | $11 | 38% |
| Genetically Handicapped Person | $11 | 38% |
| Gold Coast Medi-Cal | $11 | 38% |
| Medi-Cal Alameda Alliance For Health | $11 | 38% |
| Medi-Cal Blue Shield Promise Health | $11 | 38% |
| Medi-Cal California Health & Wellness Plan | $11 | 38% |
| Medi-Cal Cencal Health | $11 | 38% |
| Medi-Cal Community Health Group | $11 | 38% |
| Medi-Cal Contra Costa Health Plan | $11 | 38% |
| Medi-Cal Health Plan Of San Mateo | $11 | 38% |
| Medi-Cal Inland Empire Health | $11 | 38% |
| Medi-Cal Kern Family Health | $11 | 38% |
| Medi-Cal La Care Health | $11 | 38% |
| Medi-Cal Molina | $11 | 38% |
| Medi-Cal Partnership Health Plan Of Ca | $11 | 38% |
| San Francisco Health Plan Medi-Cal | $11 | 38% |
| Santa Clara Family Health Plan - Premier Health | $11 | 38% |
| Santa Clara Family Health Plan - Valley Health | $11 | 38% |
| Health Plan Of San Joaquin | $17 | 58% |
| Sante | $17 - $30 | 58% |
| Sequoia Pace | $17 | 58% |
| Adventist -Mcl Calviva Sub Cap | $19 | 65% |
| Healthnet | $22 - $372 | 76% |
| Advantek Table Mountain Rancheria Tribal Member | $30 | 103% |
| Aetna | $30 - $87 | 103% |
| Blue Shield 65 Plus Hmo Ehs | $30 | 103% |
| Blue Shield 65 Plus Hmo First Choice | $30 | 103% |
| Blue Shield Hmo-Cvmp/Medpro | $30 | 103% |
| Blue Shield Promise - Imperial | $30 | 103% |
| Blue Shield Saint Agnes | $30 | 103% |
| Blue Shield Sante | $30 | 103% |
| Brand New Day | $30 | 103% |
| Bscphp - Dhmso | $30 | 103% |
| Bscphp - First Choice | $30 | 103% |
| Bscphp Hmo - First Choice | $30 | 103% |
| Care1St Hmo - Ehs | $30 | 103% |
| Cares Act Provider Relief Fund | $30 | 103% |
| Cigna | $30 - $419 | 103% |
| Gemcare Hmo | $30 | 103% |
| Generic | $30 | 103% |
| Generic Bscphp | $30 | 103% |
| Generic Victims Of Crime | $30 | 103% |
| Hartford Life Supplement | $30 | 103% |
| Healthnet Hmo - Cvmp/Medpro | $30 | 103% |
| Healthnet Hmo - Dhmso | $30 | 103% |
| Healthnet Hmo - La Salle | $30 | 103% |
| Healthnet Hmo - Sante | $30 | 103% |
| Healthnet Sante | $30 | 103% |
| Healthnet Sante - Sub Cap Dual Risk | $30 | 103% |
| Healthnet Sante Dual Risk | $30 | 103% |
| Humana | $30 - $143 | 103% |
| Kaiser | $30 | 103% |
| Medi-Cal Innovative Integrated Health | $30 | 103% |
| Medicare (plans) | $30 | 103% |
| Meritage Blue Shield 65 Plus | $30 | 103% |
| Meritage Brand New Day | $30 | 103% |
| Meritage Healthnet Hmo | $30 | 103% |
| Railroad Part A | $30 | 103% |
| Railroad Part A & B | $30 | 103% |
| Railroad Part B | $30 | 103% |
| Sante Sub Cap Healthnet Seniority | $30 | 103% |
| Sante Sub Cap-Blue Shield/Sante | $30 | 103% |
| Sante-Blue Shield/Sante | $30 | 103% |
| Sante-Healthnet Seniority | $30 | 103% |
| Sante-Sub Cap Ma Brand New Day | $30 | 103% |
| Scan Health Plan | $30 | 103% |
| Sequoia Pace - Peak Tpa | $30 | 103% |
| Todays Pyramid | $30 | 103% |
| UnitedHealthcare | $30 - $377 | 103% |
| Us Marshal | $30 | 103% |
| Victims Of Crime | $30 | 103% |
| Well Path (Cfmg) | $30 - $185 | 103% |
| Wellcare | $30 | 103% |
| Alignment Health Plan | $34 | 117% |
| Champion Health Plan Of California Ma | $34 | 117% |
| Innovative Integrated Health Community Plans Hmo | $34 | 117% |
| Imperial Health Plan Hmo | $35 | 120% |
| Correctcare Integrated Health | $40 | 138% |
| Central Valley Medical Providers | $42 - $118 | 145% |
| Community Care | $43 | 148% |
| Coalinga State Hospital | $61 | 210% |
| Naphcare Inc-Mendota | $66 | 227% |
| Employer 90/40 | $67 | 231% |
| Central Ca Indian Health | $92 | 317% |
| Nx Health Network Ppo | $92 | 317% |
| Healthsmart | $114 - $134 | 392% |
| Coventry Health Care (First Health Network) | $126 | 434% |
| Network By Design | $126 | 434% |
| Generic Multiplan | $143 | 492% |
| Phcs | $143 | 492% |
| Physmetrics Health | $285 | 981% |