CMS Price Transparency Data

Group therapy session

Facility: Medstar Health Physical Therapy

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $293
Cash Discount Price: $284
vs. Medicare Baseline: 2.82x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Medstar Health Physical Therapy is $293. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $284. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.82x the Medicare baseline. Located in 102 Irving St Nw, Washington, DC.

Cash / Self-Pay

$284

Average discount available for prompt cash payment at this facility.

Insurance Median

$293

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$103.79

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $103.79 (100%)

Cash / Self-Pay: $284 (274%)

Insurance Median: $293 (282%)

Cash: $284 (274% of Medicare)

Ins. Median: $293 (282% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $103.79 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 282% of the Medicare baseline (a markup of 182%). 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	$106	102%
Tricare	$108	104%
UnitedHealthcare	$108 - $300	104%
Aetna	$110 - $309	106%
Health Care Service Corporation	$112	108%
Humana	$112	108%
Kaiser Permanente	$112 - $477	108%
Carefirst Blue Choice Inc	$211 - $283	203%
Jhhc	$280 - $287	270%
Pfc	$280 - $287	270%
Medstar Family Choice Inc	$306 - $314	295%
Kaiser	$337 - $345	325%
Cigna	$366 - $375	353%
First Health	$366 - $375	353%
Private Healthcare Systems (Phcs)	$366 - $375	353%

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 $284.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90853.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Medstar Health Physical Therapy is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90853.
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.