Scripps Memorial Hospital La Jolla
Scripps Memorial Hospital La Jolla charges 9.7x the Medicare reimbursement rate on average, with 32% of procedures showing significant price variations compared to other facilities.
La Jolla, CA 92037 · Acute Care Hospitals · CMS Rating: 5/5
About the analyst
Elena Vasquez leads hospital billing pattern analysis at BillRazor Research. She focuses on identifying overcharges, markup outliers, and patient advocacy strategies. Expertise: hospital billing patterns, overcharge analysis, patient advocacy.
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Billing patterns — for-profit
For-profit hospitals in our dataset demonstrate distinct billing patterns, with 628 facilities showing an average markup of 7.8 times Medicare rates. These hospitals typically maintain higher charge structures across most service categories compared to non-profit and government facilities. Common patterns include substantial charges above benchmark rates for emergency services, surgical procedures, and diagnostic imaging. Patients should be aware that initial bills from for-profit hospitals often reflect chargemaster rates rather than negotiated insurance amounts. The billing structure frequently includes separate charges for facility fees, physician services, and ancillary services that may appear as multiple line items. Before receiving care, patients can request cost estimates and inquire about financial assistance programs, which are federally required at all hospital types. Understanding that insurance negotiations typically result in significantly lower actual payments than initial charges can help patients navigate the billing process more effectively when receiving care at for-profit facilities.
Pricing grade
F
Very high
Avg markup vs Medicare
9.67x
Charge / Medicare rate
Max markup
18.29x
Worst procedure
Procedures analyzed
143
With pricing data
Outlier procedures
32.2%
Above 90th percentile
Pricing grades reflect how this hospital's chargemaster (list) rates compare to Medicare reimbursement benchmarks within the same state. Grades measure pricing patterns only — not quality of care, patient outcomes, or clinical performance. A lower grade does not mean a hospital provides inferior care. Based on publicly available federal data. Not endorsed by or affiliated with any government agency.
| Procedure | Code | Gross charge | Cash price | Medicare | Markup |
|---|---|---|---|---|---|
| UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC | 743 | $159,730 | $79,865 | — | 18.3x |
| TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC | 083 | $172,627 | $86,313 | — | 16.9x |
| TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC | 087 | $106,656 | $53,328 | — | 16.5x |
| MAJOR CHEST TRAUMA WITH MCC | 183 | $200,451 | $100,225 | — | 16.3x |
| PNEUMOTHORAX WITH CC | 200 | $125,030 | $62,515 | — | 16x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC | 066 | $74,020 | $37,010 | — | 15.9x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | 310 | $52,044 | $26,022 | — | 15.1x |
| PULMONARY EMBOLISM WITHOUT MCC | 176 | $67,241 | $33,621 | — | 14.3x |
| CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC | 236 | $472,376 | $236,188 | — | 13.7x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC | 282 | $55,646 | $27,823 | — | 13.1x |
| TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC | 086 | $125,134 | $62,567 | — | 13x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | 065 | $99,327 | $49,663 | — | 12.9x |
| OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC | 964 | $144,681 | $72,341 | — | 12.8x |
| CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC | 235 | $528,568 | $264,284 | — | 12.3x |
| LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC | 418 | $135,413 | $67,706 | — | 12.1x |
| MAJOR CHEST TRAUMA WITH CC | 184 | $91,182 | $45,591 | — | 12x |
| COMPLICATIONS OF TREATMENT WITH CC | 920 | $90,719 | $45,360 | — | 11.4x |
| OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC | 315 | $77,378 | $38,689 | — | 11.4x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC | 287 | $94,737 | $47,368 | — | 11.4x |
| MAJOR CHEST PROCEDURES WITH CC | 164 | $229,603 | $114,802 | — | 11.4x |
| OTHER VASCULAR PROCEDURES WITH MCC | 252 | $367,067 | $183,534 | — | 11.3x |
| MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC | 331 | $147,266 | $73,633 | — | 11.3x |
| GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC | 390 | $36,585 | $18,293 | — | 11.2x |
| LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC | 494 | $164,670 | $82,335 | — | 11.2x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | 309 | $54,359 | $27,179 | — | 11.2x |
| RED BLOOD CELL DISORDERS WITH MCC | 811 | $142,993 | $71,496 | — | 11.2x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | 281 | $72,482 | $36,241 | — | 11.2x |
| FRACTURES OF HIP AND PELVIS WITHOUT MCC | 536 | $62,638 | $31,319 | — | 11x |
| HEART FAILURE AND SHOCK WITH CC | 292 | $66,332 | $33,166 | — | 11x |
| TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC | 069 | $60,349 | $30,175 | — | 11x |
| COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC | 455 | $421,961 | $210,980 | — | 10.9x |
| CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION | 220 | $472,816 | $236,408 | — | 10.8x |
| ENDOCRINE DISORDERS WITH MCC | 643 | $130,783 | $65,392 | — | 10.8x |
| TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC | 605 | $66,556 | $33,278 | — | 10.8x |
| TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC | 082 | $228,625 | $114,313 | — | 10.8x |
| TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC | 085 | $198,918 | $99,459 | — | 10.7x |
| MEDICAL BACK PROBLEMS WITHOUT MCC | 552 | $71,712 | $35,856 | — | 10.6x |
| DIABETES WITH MCC | 637 | $107,203 | $53,601 | — | 10.6x |
| MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC | 470 | $154,301 | $77,150 | — | 10.5x |
| OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC | 394 | $67,682 | $33,841 | — | 10.5x |
| INTERSTITIAL LUNG DISEASE WITH MCC | 196 | $149,133 | $74,567 | — | 10.5x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC | 247 | $137,597 | $68,799 | — | 10.5x |
| CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC | 233 | $615,533 | $307,766 | — | 10.5x |
| RED BLOOD CELL DISORDERS WITHOUT MCC | 812 | $60,268 | $30,134 | — | 10.4x |
| CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC | 025 | $342,261 | $171,131 | — | 10.4x |
| DISORDERS OF THE BILIARY TRACT WITH CC | 445 | $87,604 | $43,802 | — | 10.4x |
| HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC | 481 | $172,468 | $86,234 | — | 10.3x |
| DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC | 441 | $165,817 | $82,909 | — | 10.3x |
| RENAL FAILURE WITH CC | 683 | $66,308 | $33,154 | — | 10x |
| GASTROINTESTINAL HEMORRHAGE WITH CC | 378 | $70,778 | $35,389 | — | 10x |
Showing 50 of 143 procedures
How SCRIPPS MEMORIAL HOSPITAL LA JOLLA compares to nearby hospitals
Comparison based on average markup ratios from federal hospital pricing data (FY 2024). Chargemaster rates are gross charges — they are not what most insured patients pay. Actual costs depend on your insurance plan, negotiated rates, and coverage terms. This comparison is for informational purposes only and does not constitute medical, financial, or legal advice. Verify costs directly with your provider and insurer.
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Pricing data from federal hospital transparency files and physician fee schedules. Last updated: . All data is publicly available under federal law.
FAQ — for-profit hospital billing
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Data: Federal hospital pricing data, updated annually. All data publicly available under federal law.
Methodology: Hospital gross charges divided by Medicare payment for the same DRG. A ratio of 3.0x means the hospital's listed price is 3 times what Medicare pays. Chargemaster rates are list prices — they are not what most insured patients pay. Grades measure pricing patterns only — not quality of care or clinical performance.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use