CMS Price Transparency Data
Physical therapy (gait training)
Facility: Scripps Green Hospital
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $32
- Cash Discount Price: $19
- vs. Medicare Baseline: 1.10x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Scripps Green Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.10x the Medicare baseline. Located in 10666 North Torrey Pines Road, La Jolla, CA.
Cash / Self-Pay
$19
Average discount available for prompt cash payment at this facility.
Insurance Median
$32
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: $19 (65%)
Insurance Median: $32 (110%)
Cash: $19 (65% of Medicare)
Ins. Median: $32 (110% 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.
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] | $6 | 21% |
| Blue Cross Blue Shield | $16 - $32 | 55% |
| Bc [814] | $17 | 58% |
| Imperial County Phys Med Group [855] | $17 - $26 | 58% |
| Integrated Health Partners [894] | $17 | 58% |
| Perlman Med Group [899] | $17 | 58% |
| Sharp Comm Med Grp [812] | $17 - $35 | 58% |
| Sharp Rees Stealy Med Grp [811] | $17 - $35 | 58% |
| Ucsd [807] | $17 - $35 | 58% |
| Centivo [581] | $18 | 62% |
| Cigna | $24 - $32 | 83% |
| Blue Shield [230] | $25 - $28 | 86% |
| Bs [816] | $26 - $27 | 89% |
| Health Net [340] | $26 - $80 | 89% |
| Hn [815] | $26 | 89% |
| Uh [819] | $27 | 93% |
| UnitedHealthcare | $27 - $50 | 93% |
| Aetna | $32 - $50 | 110% |
| Astiva Mcr Adv [464] | $32 | 110% |
| Bc Mcr Adv [830] | $32 | 110% |
| Bs Mcr Adv [829] | $32 | 110% |
| Central Health Mcr Adv [441] | $32 | 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% |
| Rady Children'S Hospital [825] | $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% |
| Alignment Health Plan [443] | $33 | 114% |
| Palomar Health [892] | $35 | 120% |
| Veba Med Grp [813] | $35 | 120% |
| Kaiser Northern Ca Region Hmo/Ppo [384] | $42 | 145% |
| Kaiser [380] | $42 | 145% |
| Kaiser [383] | $42 | 145% |
| Prime Healthcare [614] | $54 | 186% |
| Multi Plan Network [470] | $55 | 189% |
| Prospect Med Group [893] | $56 | 193% |
| First Health Network [330] | $58 | 200% |
| Pnoa [615] | $58 | 200% |
| Choice Care Network [270] | $62 | 213% |
| Healthsmart [350] | $62 | 213% |