Physical therapy (neuromuscular re-education)
Facility: Medstar Harbor Hospital
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $193
- Cash Discount Price: $189
- vs. Medicare Baseline: 5.90x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 590% of the Medicare baseline (a markup of 490%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $119 - $215 | 364% |
| Amerigroup | $119 - $215 | 364% |
| Amerihealth Caritas District Of Columbia | $119 - $215 | 364% |
| Carefirst Advantage Inc | $119 - $215 | 364% |
| Carefirst Blue Choice Inc | $119 - $215 | 364% |
| Cigna | $119 - $215 | 364% |
| First Health | $119 - $215 | 364% |
| Hscsn | $119 - $215 | 364% |
| Humana | $119 - $215 | 364% |
| Kaiser Permanente | $119 - $215 | 364% |
| Magellan Behavioral Health Inc | $119 - $215 | 364% |
| Mamsi | $119 - $215 | 364% |
| Medstar Family Choice | $119 - $215 | 364% |
| Medstar Family Choice Inc | $119 - $215 | 364% |
| Ncppo Healthlink Ppo | $119 - $215 | 364% |
| Pfc | $119 - $215 | 364% |
| Private Healthcare Systems (Phcs) | $119 - $215 | 364% |
| Tricare | $119 - $215 | 364% |
| United Behavioral Health Inc | $119 - $215 | 364% |
| UnitedHealthcare | $119 - $215 | 364% |
Consumer Guidance & Cost Commentary
Before scheduling care, a self-pay patient should know that paying cash directly for this physical therapy service costs exactly $189, which is lower than the facility's gross charge of $193. While commercial insurance plans typically negotiate rates between $119 and $215, these negotiated amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket and checking for "self-pay" or "prompt-pay" discounts with Medstar Harbor Hospital. It is important to verify the exact rate before check-in to ensure the billing system does not automatically submit a claim to the insurer, which could void any cash discount agreement.
The facility's cash rate of $189 is significantly higher than the Medicare benchmark of $32.73, illustrating the substantial markup common in commercial healthcare pricing. Although the data provided does not include specific state or county average comparisons for this code, patients should be aware that commercial rates often range from 200% to 300% of the Medicare base, whereas fair pricing is typically defined between 120% and 150%. To minimize costs, consumers should request an itemized bill to review every line item for potential errors such as unbundled codes or services not rendered, as over 80% of hospital bills contain mistakes that can be disputed in writing.