CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Scripps Mercy Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $59
Cash Discount Price: $47
vs. Medicare Baseline: 2.03x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Scripps Mercy Hospital is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.03x the Medicare baseline. Located in 4077 5Th Ave, San Diego, CA.

Cash / Self-Pay

$47

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $47 (162%)

Insurance Median: $59 (203%)

Cash: $47 (162% of Medicare)

Ins. Median: $59 (203% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 203% of the Medicare baseline (a markup of 103%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Radys Cpmg [803]	$14 - $16	48%
Aetna	$32 - $103	110%
Astiva Mcr Adv [464]	$32	110%
Bc Mcr Adv [830]	$32	110%
Blue Cross Blue Shield	$32 - $59	110%
Bs Mcr Adv [829]	$32	110%
Central Health Mcr Adv [441]	$32	110%
Cigna	$32 - $81	110%
Clever Care Mcr Adv [465]	$32	110%
D-Snp Mcr Adv [889]	$32	110%
Dsnp/Csnp - Generic [458]	$32	110%
Family Health Centers Pace Mcr Adv Hmo [556]	$32	110%
Family Health Centers Pace Medi-Cal [555]	$32	110%
Gary And Mary West Pace Medi-Cal Hmo [557]	$32	110%
Gpmg/Altura - Mcr Adv [888]	$32	110%
Hn Mcr Adv [832]	$32	110%
Humana	$32	110%
Integrated Health Partners - Mcr Adv [895]	$32	110%
Kaiser Northern Ca Region Mcr Adv [386]	$32	110%
La Care Mcr Adv Hmo [612]	$32	110%
Medicare (plans)	$32	110%
Mpmg Mcr Adv [836]	$32	110%
Mpmg [800]	$32	110%
Ocn Mcr Adv [890]	$32	110%
San Diego Pace Medi-Cal [553]	$32	110%
Scan Mcr Adv [835]	$32	110%
Scan [500]	$32	110%
Scan [818]	$32	110%
Sharp Comm Med Grp Mcr Adv [840]	$32	110%
Sharp Health Plan Mcr Adv [531]	$32	110%
Sharp Health Plan Mcr Adv [897]	$32	110%
Sharp Rees Stealy Med Grp Mcr Adv [841]	$32	110%
St Paul'S Pace Medi-Cal [551]	$32	110%
Ucsd Mcr Adv [873]	$32	110%
Uh Mcr Adv [831]	$32	110%
Uh Palomar Health Mcr Adv [885]	$32	110%
UnitedHealthcare	$32 - $72	110%
Alignment Health Plan [443]	$33	114%
Bc [814]	$38 - $45	131%
Imperial County Phys Med Group [855]	$38 - $70	131%
Integrated Health Partners [894]	$38 - $45	131%
Perlman Med Group [899]	$38 - $45	131%
Sharp Comm Med Grp [812]	$38 - $93	131%
Sharp Rees Stealy Med Grp [811]	$38 - $93	131%
Ucsd [807]	$38 - $93	131%
Centivo [581]	$40 - $47	138%
Health Net [340]	$51 - $80	175%
Prime Healthcare [614]	$54	186%
Prospect Med Group [893]	$56	193%
Blue Shield [230]	$57 - $73	196%
Hn [815]	$58 - $69	200%
Bs [816]	$59 - $73	203%
Mc Alignment [917]	$59	203%
Mc Blue Shield Promise Health Plan [914]	$59	203%
Mc Blue Shield [902]	$59	203%
Mc Health Net [904]	$59	203%
Mc Scan [905]	$59	203%
Mc United [906]	$59	203%
Uh [819]	$60 - $72	206%
Kaiser Northern Ca Region Hmo/Ppo [384]	$65 - $77	224%
Kaiser [380]	$65 - $77	224%
Kaiser [383]	$65 - $77	224%
Rady Children'S Hospital [825]	$71 - $84	244%
Palomar Health [892]	$78 - $93	268%
Veba Med Grp [813]	$78 - $93	268%
Multi Plan Network [470]	$123 - $145	423%
First Health Network [330]	$130 - $154	447%
Pnoa [615]	$130 - $154	447%
Choice Care Network [270]	$138 - $164	475%
Healthsmart [350]	$138 - $164	475%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $47.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97110.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Scripps Mercy Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97110.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.