How many shoppable procedure prices are published for Scripps Mercy Hospital?

Scripps Mercy Hospital in San Diego, CA currently has 94 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Scripps Mercy Hospital's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Scripps Mercy Hospital's median negotiated commercial rate is 1.3× the regionally adjusted fair BaseRate benchmark.

What is Scripps Mercy Hospital's CMS Care Compare overall star rating?

CMS Care Compare assigns Scripps Mercy Hospital an overall hospital quality rating of 4 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 487 Beds · rural Updated: 2026-03-30

Scripps Mercy Hospital

4077 5Th Ave, San Diego, CA 92103 · 94 Priced Procedures · 68% Patient Recommendation

CMS Overall Rating 4 / 5 Stars

Above Fair Market · Negotiate

1.31×vs. Fair Market Price

Typical commercial prices here are +31% above the fair benchmark (1.31×) even after accounting for local nurse/doctor wages and patient complexity.

87/100 · Verified

87/100Self-Pay Cash Beats Insurance 58% of the Time

File Completeness85

Price Logic98

Peer Alignment61

Clean Billing87

Real Cash Discount100

Regional Value Leader

3-Star CMS clinical quality rating paired with 1.31× fair market pricing.

Behavioral Pricing FingerprintMedian-Gamed · High Captive Markup

Loss-Leader / Captive Ancillary Cross-Subsidizer

Scripps Mercy Hospital prices routine shoppable procedures near 1.5× Medicare (p50 1.43×) while skewing captive emergency, lab, and upper-quartile codes to 2.6× Medicare (p75 1.80×, +26% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.

#164 of 240 in CA · 67th State Percentile#2,259 of 3,385 in U.S. · 66th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 1.00× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 58% of shoppable procedures (99/100 Cash Honesty)
4-Star CMS clinical rating with 68% patient recommendation (67/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (24.0% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 3.7× markup over Medicare rates
Captive ER (1.7×) & laboratory (2.0×) services average 1.73× higher multiples than routine shoppable care (1.5×)
Upper-quartile procedures (Q75 1.80×) jump +26% above the median procedure ratio (Q50 1.43×)
Unnegotiated chargemaster list prices average 11.4× Medicare (14¢ true HCRIS cost per $1 gross)

Front-Door ShoppableElective / Imaging

1.5× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.73× Divergence

2.6× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+26% Upper Tail

Q25 1.00× · Q50 1.43× · Q75 1.80×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

1.5× MedicareGood

Outpatient Surgery & ORBack-Door Captive

3.7× MedicareElevated

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

1.0× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

1.7× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

2.0× MedicareGood

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

0.5× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

58% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

4 CMS · 67/100Fair

Procedure Prices at Scripps Mercy Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 94 published procedures.

Sort:

Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Heart stent placement (inpatient stay) MS-DRG Code: `322`	$30,750	$30,750	$17,936	1.7×
Trauma team activation HCPCS Code: `G0390`	$15,442	$18,531	$1,453	unverified
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	$17,548	$17,548	$19,087	0.9×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	$9,991	$8,944	$8,223	1.1×
Gallbladder removal (laparoscopic) CPT Code: `47562`	$12,439	$8,359	$6,109	1.4×
Breast lump removal CPT Code: `19120`	$4,987	$5,036	$3,875	unverified
Inguinal hernia repair CPT Code: `49505`	$3,909	$4,605	$3,629	1.3×
Knee arthroscopy with meniscus repair CPT Code: `29881`	$2,964	$4,208	$3,372	1.2×
Bunion correction surgery CPT Code: `28296`	$1,830	$4,208	$3,446	1.2×
Cataract surgery with lens implant CPT Code: `66984`	$1,944	$2,968	$2,540	1.2×
Colonoscopy with biopsy CPT Code: `45380`	$972	$1,539	$1,256	1.2×
Colonoscopy (diagnostic) CPT Code: `45378`	$749	$1,196	$981	1.2×
Upper endoscopy with biopsy CPT Code: `43239`	$649	$1,167	$987	unverified
Sleep study (overnight, in lab) CPT Code: `95810`	$578	$1,104	$1,021	1.1×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$426	$703	$583	1.2×
Blood transfusion CPT Code: `36430`	$338	$567	$498	1.1×
Rabies immune globulin HCPCS Code: `90375`	$754	$560	$322	unverified
MRI, brain (with and without contrast) CPT Code: `70553`	$1,476	$471	$511	unverified
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$2,250	$471	$448	unverified
MRI, knee or other leg joint CPT Code: `73721`	$1,301	$347	$369	unverified
MRI, brain (no contrast) CPT Code: `70551`	$913	$307	$343	unverified
MRI, lower back (no contrast) CPT Code: `72148`	$753	$307	$338	unverified
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$1,457	$322	$303	unverified
Breathing treatment (nebulizer) CPT Code: `94640`	$95	$282	$201	1.4×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$276	$307	$272	unverified
Ultrasound, thyroid and neck CPT Code: `76536`	$522	$250	$132	unverified
Ultrasound, abdomen (complete) CPT Code: `76700`	$342	$233	$134	unverified
Ultrasound, pelvis CPT Code: `76856`	$578	$250	$130	unverified
CT scan, head (no contrast) CPT Code: `70450`	$864	$207	$160	unverified
CT scan, head (with contrast) CPT Code: `70460`	$940	$226	$242	unverified
CT scan, head (with and without contrast) CPT Code: `70470`	$1,016	$237	$258	unverified
Ultrasound, abdomen (limited) CPT Code: `76705`	$407	$249	$126	unverified
CT scan, sinuses CPT Code: `70486`	$1,833	$207	$166	unverified
CT scan, neck (cervical spine) CPT Code: `72125`	$1,725	$207	$169	unverified
X-ray, neck (cervical spine) CPT Code: `72040`	$244	$156	$93	1.7×
X-ray, foot CPT Code: `73630`	$284	$178	$92	unverified
X-ray, chest (two views) CPT Code: `71046`	$244	$146	$93	1.6×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	$43,536	$165	$19,432	unverified
X-ray, lower back CPT Code: `72110`	$292	$187	$112	unverified
X-ray, hand CPT Code: `73130`	$410	$178	$93	unverified
Diagnostic mammogram (both breasts) CPT Code: `77066`	$224	$189	$148	unverified
X-ray, pelvis CPT Code: `72170`	$119	$134	$110	1.2×
X-ray, chest (single view) CPT Code: `71045`	$76	$112	$92	1.2×
X-ray, hip CPT Code: `73502`	$70	$112	$93	1.2×
CT scan, chest (no contrast) CPT Code: `71250`	$525	$134	$167	unverified
CT scan, lower back (lumbar spine) CPT Code: `72131`	$480	$134	$168	unverified
CT scan, pelvis CPT Code: `72192`	$364	$134	$163	unverified
X-ray, shoulder CPT Code: `73030`	$304	$156	$92	unverified
X-ray, ankle CPT Code: `73610`	$341	$146	$93	unverified
Screening mammogram (both breasts) CPT Code: `77067`	$181	$152	$123	unverified
Hepatitis B immune globulin HCPCS Code: `90371`	$292	$153	$151	unverified
Office visit, established patient (20-29 min) CPT Code: `99213`	$73	$104	$87	1.2×
Speech therapy (language evaluation) CPT Code: `92507`	$64	$84	$86	1.0×
Typhoid vaccine HCPCS Code: `90675`	$426	$377	$347	unverified
Colorectal cancer screening HCPCS Code: `G0010`	$188	$159	$49	unverified
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$79	$108	$111	1.0×
Culture, blood CPT Code: `87040`	$185	$111	$11	unverified
Blood antibody screen CPT Code: `86850`	$49	$67	$46	1.5×
Flu vaccine injection HCPCS Code: `G0008`	$45	$60	$48	1.3×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$104	$76	$64	1.2×
Orthotic fitting and training CPT Code: `97760`	$33	$52	$51	1.0×
Pneumonia vaccine injection HCPCS Code: `G0009`	$86	$76	$49	unverified
Physical therapy (functional capacity test) CPT Code: `97750`	$24	$38	$38	1.0×
Prosthetic fitting and training CPT Code: `97761`	$23	$45	$45	1.0×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$26	$39	$40	1.0×
Occupational therapy (self-care training) CPT Code: `97535`	$25	$36	$38	0.9×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$98	$59	$11	unverified
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$56	$60	$56	unverified
Blood test, creatinine (kidney) CPT Code: `82565`	$6	$5	$5	1.0×
Speech therapy (group session) CPT Code: `92508`	$16	$27	$27	1.0×
Physical therapy (gait training) CPT Code: `97116`	$19	$32	$33	1.0×
Hepatitis B vaccine HCPCS Code: `90744`	$29	$25	$37	0.7×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$29	$36	$38	unverified
Blood test, hemoglobin CPT Code: `85018`	$3	$2	$3	0.7×
Flu vaccine (high dose) HCPCS Code: `90656`	$13	$12	$25	0.5×
Blood test, basic metabolic panel CPT Code: `80048`	$61	$20	$9	unverified
Blood test, liver function panel CPT Code: `80076`	$71	$20	$9	unverified
Urinalysis (automated, with microscopy) CPT Code: `81001`	$35	$8	$3	unverified
Blood test, amylase CPT Code: `82150`	$16	$10	$7	unverified
Blood test, calcium CPT Code: `82310`	$10	$6	$5	unverified
Blood test, glucose (blood sugar) CPT Code: `82947`	$6	$4	$4	unverified
Blood test, average blood sugar (A1c) CPT Code: `83036`	$13	$10	$10	unverified
Blood test, lipase CPT Code: `83690`	$75	$17	$7	unverified
Blood test, magnesium CPT Code: `83735`	$16	$11	$7	unverified
Blood test, potassium CPT Code: `84132`	$12	$7	$5	unverified
Blood test, PSA (prostate screen) CPT Code: `84153`	$32	$20	$19	unverified
Blood test, sodium CPT Code: `84295`	$11	$7	$5	unverified
Blood test, thyroid (TSH) CPT Code: `84443`	$34	$21	$18	unverified
Physical therapy (therapeutic exercise) CPT Code: `97110`	$51	$32	$35	unverified
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$9	$6	$4	unverified
Blood test, complete blood count (CBC) CPT Code: `85025`	$28	$17	$8	unverified
Blood test, clotting time (PT/INR) CPT Code: `85610`	$26	$8	$5	unverified
Blood test, clotting time (PTT) CPT Code: `85730`	$34	$11	$6	unverified
Physical therapy (manual therapy) CPT Code: `97140`	$39	$31	$34	unverified

Showing top 25 high-impact procedures of 94 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 24.0%

Audit a Bill or Quote at Scripps Mercy Hospital (Zero PHI Required)

CMS CCN: 050077

CPT 322

Select Procedure to Audit:

Fair BaseRate™ $17,936

Medicare Rate $12,807

Self-Pay Cash $30,750

Insurer Median $30,750

1. Amount on Your Bill or Quote ($) Pre-filled with Scripps Mercy Hospital’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $29,520 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $29,520

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (24.0% of gross = $29,520).

Step 2 · Cash vs. Insurance Arbitrage Save $92,248 Paying Cash

Self-Pay Cash Rate ($30,750) Beats Your Bill

Scripps Mercy Hospital's published 45 CFR § 180 self-pay cash rate is $30,750 (vs. $30,750 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$105,062 Above Fair BaseRate

Negotiate Toward $17,936 Fair BaseRate ($12,807 Medicare)

Your bill ($122,998) is $105,062 above the denoised Fair BaseRate ($17,936) and 9.6× the $12,807 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

EIN: 951684089

Filing Period: 195509

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold

Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier

Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported

26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (24.0% of gross charges)

Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall3/5 Stars (3/5)

Safety Composite67/100

Would Recommend68%

Rated 9 or 10 (HCAHPS)67%

Median ER Wait193 min

Left ER Before Seen3%

30-Day Mortality vs U.S.better

Unplanned Readmissionsame

Hip/Knee Complication Rate3.3%

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

Central-Line Bloodstream Infectionsame

C. diff Hospital-Onset Infectionbetter

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Scripps Mercy Hospital. Prior administrative notices do not necessarily reflect current compliance status.

2025-05-09·administrative_or_closure
Closure Notice
Recorded
2025-04-24·warning_notice
Warning Notice
Recorded
2022-01-28·administrative_or_closure
Closure Notice
Recorded
2021-10-27·cap_corrective_action
CAP Request
Recorded
2021-05-18·warning_notice
Warning Notice
Recorded

Source: CMS Hospital Care Compare (2,872 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Regional Value & Quality Leader

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Scripps Mercy Hospital.

Price Index: 0.82× regional baseline

Quality: 68/100 CMS composite

Median Household Income$102,285U.S. Census ACS

Local Uninsured Share6.8%Regional ACS estimate

200% FPL (1 Person)$31,920Common free-care ceiling

400% FPL (Family of 4)$128,600Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 87/100 · Verified CMS CCN 050077 EIN 951684089

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 050077) ↗ Verify IRS Form 990 (EIN 951684089) ↗ CMS HCRIS Cost Reports ↗

Published MRF File951684089_Scripps-Mercy-Hospital-San-Diego_standardcharges.csv

Publication / Vintage2026-03-30 · 551.92 MB

Validated Rate Rows13,828 (CMS v3.0.0)

File Integrity Digest73e99955e6cacd4cd24b…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy