CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Medstar Georgetown University Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $170
Cash Discount Price: $171
vs. Medicare Baseline: 5.19x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Medstar Georgetown University Hospital is $170. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $171. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 5.19x the Medicare baseline. Located in 3800 Reservoir Rd, Washington, DC.

Cash / Self-Pay

$171

Average discount available for prompt cash payment at this facility.

Insurance Median

$170

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $171 (522%)

Insurance Median: $170 (519%)

Cash: $171 (522% of Medicare)

Ins. Median: $170 (519% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 519% of the Medicare baseline (a markup of 419%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Carefirst Advantage Inc	$36	110%
Tricare	$36	110%
UnitedHealthcare	$36 - $92	110%
Aetna	$38 - $106	116%
Health Care Service Corporation	$38	116%
Humana	$38	116%
Blue Cross Blue Shield	$56	171%
Medstar Family Choice Inc	$152 - $337	464%
Cigna	$170	519%
Pfc	$171	522%
Carefirst Blue Choice Inc	$194	593%
Private Healthcare Systems (Phcs)	$210	642%
First Health	$223	681%
Beech Street	$236	721%
Amerigroup	$337	1030%
Amerihealth Caritas District Of Columbia	$337	1030%
Hscsn	$337	1030%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $171.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Medstar Georgetown University Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97112.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.