CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Scripps Memorial Hospital La Jolla
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $74
- Cash Discount Price: $73
- vs. Medicare Baseline: 0.78x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Scripps Memorial Hospital La Jolla is $74. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.78x the Medicare baseline. Located in 9888 Genesee Avenue, La Jolla, CA.
Cash / Self-Pay
$73
Average discount available for prompt cash payment at this facility.
Insurance Median
$74
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%)
Cash / Self-Pay: $73 (77%)
Insurance Median: $74 (78%)
Cash: $73 (77% of Medicare)
Ins. Median: $74 (78% 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 |
|---|---|---|
| Radys Cpmg [803] | $24 | 25% |
| Blue Cross Blue Shield | $44 - $171 | 46% |
| Cigna | $44 - $171 | 46% |
| Mc Alignment [917] | $44 | 46% |
| Mc Blue Shield Promise Health Plan [914] | $44 | 46% |
| Mc Blue Shield [902] | $44 | 46% |
| Mc Health Net [904] | $44 | 46% |
| Mc Scan [905] | $44 | 46% |
| Mc United [906] | $44 | 46% |
| Blue Shield [230] | $51 - $55 | 54% |
| Bs [816] | $53 - $55 | 56% |
| Imperial County Phys Med Group [855] | $53 - $62 | 56% |
| Sharp Comm Med Grp [812] | $53 - $74 | 56% |
| Sharp Rees Stealy Med Grp [811] | $53 - $74 | 56% |
| Ucsd [807] | $53 - $74 | 56% |
| Mpmg Mcr Adv [836] | $60 | 63% |
| Mpmg [800] | $60 | 63% |
| Ocn Mcr Adv [890] | $60 | 63% |
| UnitedHealthcare | $60 - $180 | 63% |
| Bc [814] | $62 | 65% |
| Integrated Health Partners [894] | $62 | 65% |
| Perlman Med Group [899] | $62 | 65% |
| Centivo [581] | $68 | 71% |
| Health Net [340] | $73 - $428 | 77% |
| Hn [815] | $73 | 77% |
| Uh [819] | $73 | 77% |
| Aetna | $74 - $171 | 78% |
| Palomar Health [892] | $74 | 78% |
| Veba Med Grp [813] | $74 | 78% |
| Prime Healthcare [614] | $101 | 106% |
| Prospect Med Group [893] | $104 | 109% |
| Kaiser Northern Ca Region Hmo/Ppo [384] | $112 | 118% |
| Kaiser [380] | $112 | 118% |
| Kaiser [383] | $112 | 118% |
| Rady Children'S Hospital [825] | $120 | 126% |
| Astiva Mcr Adv [464] | $171 | 180% |
| Bc Mcr Adv [830] | $171 | 180% |
| Bs Mcr Adv [829] | $171 | 180% |
| Central Health Mcr Adv [441] | $171 | 180% |
| Clever Care Mcr Adv [465] | $171 | 180% |
| D-Snp Mcr Adv [889] | $171 | 180% |
| Dsnp/Csnp - Generic [458] | $171 | 180% |
| Family Health Centers Pace Mcr Adv Hmo [556] | $171 | 180% |
| Family Health Centers Pace Medi-Cal [555] | $171 | 180% |
| Gary And Mary West Pace Medi-Cal Hmo [557] | $171 | 180% |
| Gpmg/Altura - Mcr Adv [888] | $171 | 180% |
| Hn Mcr Adv [832] | $171 | 180% |
| Humana | $171 | 180% |
| Integrated Health Partners - Mcr Adv [895] | $171 | 180% |
| Kaiser Northern Ca Region Mcr Adv [386] | $171 | 180% |
| La Care Mcr Adv Hmo [612] | $171 | 180% |
| Medicare (plans) | $171 | 180% |
| San Diego Pace Medi-Cal [553] | $171 | 180% |
| Scan Mcr Adv [835] | $171 | 180% |
| Scan [500] | $171 | 180% |
| Scan [818] | $171 | 180% |
| Sharp Comm Med Grp Mcr Adv [840] | $171 | 180% |
| Sharp Health Plan Mcr Adv [531] | $171 | 180% |
| Sharp Health Plan Mcr Adv [897] | $171 | 180% |
| Sharp Rees Stealy Med Grp Mcr Adv [841] | $171 | 180% |
| St Paul'S Pace Medi-Cal [551] | $171 | 180% |
| Ucsd Mcr Adv [873] | $171 | 180% |
| Uh Mcr Adv [831] | $171 | 180% |
| Uh Palomar Health Mcr Adv [885] | $171 | 180% |
| Alignment Health Plan [443] | $176 | 185% |
| Multi Plan Network [470] | $209 | 220% |
| First Health Network [330] | $220 | 231% |
| Pnoa [615] | $220 | 231% |
| Choice Care Network [270] | $235 | 247% |
| Healthsmart [350] | $235 | 247% |