CMS Price Transparency Data
Physical therapy (neuromuscular re-education)
Facility: Scripps Mercy Hospital
Billing Code: 97112 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97112
- Insurance Median: $38
- Cash Discount Price: $28
- vs. Medicare Baseline: 1.16x Medicare
The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Scripps Mercy Hospital is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.16x the Medicare baseline. Located in 4077 5Th Ave, San Diego, CA.
Cash / Self-Pay
$28
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
$32.73
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $32.73 (100%)
Cash / Self-Pay: $28 (86%)
Insurance Median: $38 (116%)
Cash: $28 (86% of Medicare)
Ins. Median: $38 (116% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $32.73 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
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 |
|---|---|---|
| Radys Cpmg [803] | $9 | 27% |
| Blue Cross Blue Shield | $23 - $59 | 70% |
| Bc [814] | $24 - $25 | 73% |
| Imperial County Phys Med Group [855] | $24 - $39 | 73% |
| Integrated Health Partners [894] | $24 - $25 | 73% |
| Perlman Med Group [899] | $24 - $25 | 73% |
| Sharp Comm Med Grp [812] | $24 - $52 | 73% |
| Sharp Rees Stealy Med Grp [811] | $24 - $52 | 73% |
| Ucsd [807] | $24 - $52 | 73% |
| Centivo [581] | $25 - $26 | 76% |
| Cigna | $25 - $59 | 76% |
| Mc Alignment [917] | $25 - $59 | 76% |
| Mc Blue Shield Promise Health Plan [914] | $25 - $59 | 76% |
| Mc Blue Shield [902] | $25 - $59 | 76% |
| Mc Health Net [904] | $25 - $59 | 76% |
| Mc Scan [905] | $25 - $59 | 76% |
| Mc United [906] | $25 - $59 | 76% |
| Aetna | $36 - $58 | 110% |
| Astiva Mcr Adv [464] | $36 | 110% |
| Bc Mcr Adv [830] | $36 | 110% |
| Blue Shield [230] | $36 - $41 | 110% |
| Bs Mcr Adv [829] | $36 | 110% |
| Central Health Mcr Adv [441] | $36 | 110% |
| Clever Care Mcr Adv [465] | $36 | 110% |
| D-Snp Mcr Adv [889] | $36 | 110% |
| Dsnp/Csnp - Generic [458] | $36 | 110% |
| Family Health Centers Pace Mcr Adv Hmo [556] | $36 | 110% |
| Family Health Centers Pace Medi-Cal [555] | $36 | 110% |
| Gary And Mary West Pace Medi-Cal Hmo [557] | $36 | 110% |
| Gpmg/Altura - Mcr Adv [888] | $36 | 110% |
| Hn Mcr Adv [832] | $36 | 110% |
| Humana | $36 | 110% |
| Integrated Health Partners - Mcr Adv [895] | $36 | 110% |
| Kaiser Northern Ca Region Mcr Adv [386] | $36 | 110% |
| La Care Mcr Adv Hmo [612] | $36 | 110% |
| Medicare (plans) | $36 | 110% |
| Mpmg Mcr Adv [836] | $36 | 110% |
| Mpmg [800] | $36 | 110% |
| Ocn Mcr Adv [890] | $36 | 110% |
| San Diego Pace Medi-Cal [553] | $36 | 110% |
| Scan Mcr Adv [835] | $36 | 110% |
| Scan [500] | $36 | 110% |
| Scan [818] | $36 | 110% |
| Sharp Comm Med Grp Mcr Adv [840] | $36 | 110% |
| Sharp Health Plan Mcr Adv [531] | $36 | 110% |
| Sharp Health Plan Mcr Adv [897] | $36 | 110% |
| Sharp Rees Stealy Med Grp Mcr Adv [841] | $36 | 110% |
| St Paul'S Pace Medi-Cal [551] | $36 | 110% |
| Ucsd Mcr Adv [873] | $36 | 110% |
| Uh Mcr Adv [831] | $36 | 110% |
| Uh Palomar Health Mcr Adv [885] | $36 | 110% |
| UnitedHealthcare | $36 - $50 | 110% |
| Alignment Health Plan [443] | $37 | 113% |
| Health Net [340] | $37 - $90 | 113% |
| Hn [815] | $37 - $39 | 113% |
| Bs [816] | $38 - $41 | 116% |
| Uh [819] | $39 - $40 | 119% |
| Kaiser Northern Ca Region Hmo/Ppo [384] | $41 - $43 | 125% |
| Kaiser [380] | $41 - $43 | 125% |
| Kaiser [383] | $41 - $43 | 125% |
| Rady Children'S Hospital [825] | $45 - $47 | 137% |
| Palomar Health [892] | $50 - $52 | 153% |
| Veba Med Grp [813] | $50 - $52 | 153% |
| Prime Healthcare [614] | $61 | 186% |
| Prospect Med Group [893] | $63 | 192% |
| Multi Plan Network [470] | $79 - $82 | 241% |
| First Health Network [330] | $83 - $86 | 254% |
| Pnoa [615] | $83 - $86 | 254% |
| Choice Care Network [270] | $88 - $92 | 269% |
| Healthsmart [350] | $88 - $92 | 269% |