CMS Price Transparency Data
Physical therapy (functional capacity test)
Facility: Scripps Mercy Hospital
Billing Code: 97750 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97750
- Insurance Median: $38
- Cash Discount Price: $24
- vs. Medicare Baseline: 1.13x Medicare
The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Scripps Mercy Hospital is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 1.13x the Medicare baseline. Located in 4077 5Th Ave, San Diego, CA.
Cash / Self-Pay
$24
Average discount available for prompt cash payment at this facility.
Insurance Median
$38
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$33.73
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $33.73 (100%)
Cash / Self-Pay: $24 (71%)
Insurance Median: $38 (113%)
Cash: $24 (71% of Medicare)
Ins. Median: $38 (113% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $33.73 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 |
|---|---|---|
| Radys Cpmg [803] | $8 | 24% |
| Blue Cross Blue Shield | $20 - $38 | 59% |
| Bc [814] | $21 | 62% |
| Imperial County Phys Med Group [855] | $21 - $33 | 62% |
| Integrated Health Partners [894] | $21 | 62% |
| Perlman Med Group [899] | $21 | 62% |
| Sharp Comm Med Grp [812] | $21 - $44 | 62% |
| Sharp Rees Stealy Med Grp [811] | $21 - $44 | 62% |
| Ucsd [807] | $21 - $44 | 62% |
| Centivo [581] | $22 | 65% |
| Cigna | $31 - $38 | 92% |
| Blue Shield [230] | $32 - $35 | 95% |
| Health Net [340] | $32 - $94 | 95% |
| Hn [815] | $32 | 95% |
| Bs [816] | $33 - $34 | 98% |
| Uh [819] | $34 | 101% |
| UnitedHealthcare | $34 - $50 | 101% |
| Kaiser Northern Ca Region Hmo/Ppo [384] | $36 | 107% |
| Kaiser [380] | $36 | 107% |
| Kaiser [383] | $36 | 107% |
| Aetna | $38 - $50 | 113% |
| Astiva Mcr Adv [464] | $38 | 113% |
| Bc Mcr Adv [830] | $38 | 113% |
| Bs Mcr Adv [829] | $38 | 113% |
| Central Health Mcr Adv [441] | $38 | 113% |
| Clever Care Mcr Adv [465] | $38 | 113% |
| D-Snp Mcr Adv [889] | $38 | 113% |
| Dsnp/Csnp - Generic [458] | $38 | 113% |
| Family Health Centers Pace Mcr Adv Hmo [556] | $38 | 113% |
| Family Health Centers Pace Medi-Cal [555] | $38 | 113% |
| Gary And Mary West Pace Medi-Cal Hmo [557] | $38 | 113% |
| Gpmg/Altura - Mcr Adv [888] | $38 | 113% |
| Hn Mcr Adv [832] | $38 | 113% |
| Humana | $38 | 113% |
| Integrated Health Partners - Mcr Adv [895] | $38 | 113% |
| Kaiser Northern Ca Region Mcr Adv [386] | $38 | 113% |
| La Care Mcr Adv Hmo [612] | $38 | 113% |
| Medicare (plans) | $38 | 113% |
| Mpmg Mcr Adv [836] | $38 | 113% |
| Mpmg [800] | $38 | 113% |
| Ocn Mcr Adv [890] | $38 | 113% |
| San Diego Pace Medi-Cal [553] | $38 | 113% |
| Scan Mcr Adv [835] | $38 | 113% |
| Scan [500] | $38 | 113% |
| Scan [818] | $38 | 113% |
| Sharp Comm Med Grp Mcr Adv [840] | $38 | 113% |
| Sharp Health Plan Mcr Adv [531] | $38 | 113% |
| Sharp Health Plan Mcr Adv [897] | $38 | 113% |
| Sharp Rees Stealy Med Grp Mcr Adv [841] | $38 | 113% |
| St Paul'S Pace Medi-Cal [551] | $38 | 113% |
| Ucsd Mcr Adv [873] | $38 | 113% |
| Uh Mcr Adv [831] | $38 | 113% |
| Uh Palomar Health Mcr Adv [885] | $38 | 113% |
| Alignment Health Plan [443] | $39 | 116% |
| Rady Children'S Hospital [825] | $40 | 119% |
| Palomar Health [892] | $44 | 130% |
| Veba Med Grp [813] | $44 | 130% |
| Prime Healthcare [614] | $64 | 190% |
| Prospect Med Group [893] | $66 | 196% |
| Multi Plan Network [470] | $69 | 205% |
| First Health Network [330] | $72 | 213% |
| Pnoa [615] | $72 | 213% |
| Choice Care Network [270] | $77 | 228% |
| Healthsmart [350] | $77 | 228% |