CMS Price Transparency Data

Physical therapy (gait training)

Facility: Scripps Memorial Hospital - Encinitas

Billing Code: 97116 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$32

about 1.1× the $29 Medicare rate · typically $27–$34

modeled estimate · not a bill or quote

What this hospital charges insurers

$32

About the fair price

1.1× Medicare

Medicare pays $29 Fair price $32 This hospital $32 Cash price $19 Hospital's list price $77

How we calculate the fair BaseRate →

How this hospital compares to other CA hospitals

Highest price of the 9 CA hospitals we have prices for — worth calling around.

Cheapest $13 Priciest $32

Black dot = this hospital, among the 9 CA hospitals with a price for this procedure. Full list below.

A fair price for a Physical therapy (gait training) is about $32 (about 1.1× the $29 Medicare rate). Scripps Memorial Hospital - Encinitas charges insurers about $32, or about $19 in cash — about the fair price. Located in Encinitas, CA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$27 - $50	93%
Blue Cross Blue Shieldmajor	$16 - $32	55%
Aetnamajor	$32 - $50	110%
Cignamajor	$24 - $32	83%
Humanamajor	$32	110%
Kaiser Permanentemajor	$32 - $44	110%
Health Net	$26 - $80	89%
HealthPartners	$17 - $32	58%
+ 38 smaller / regional plans	$6 - $62

Government programs also on file: Medicare, Medicaid.

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 19), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97116.

Insurance Before you use insurance

Call your insurance company to confirm Scripps Memorial Hospital - Encinitas is in-network.
Ask your insurer whether prior approval is required for CPT code 97116.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Scripps Memorial Hospital - Encinitas

Compare: Physical therapy (gait training) at other CA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.