CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Norton-King's Daughters' Health

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $152
Cash Discount Price: $39
vs. Medicare Baseline: 4.51x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Norton-King's Daughters' Health is $152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $39. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 4.51x the Medicare baseline. Located in 1373 East Sr 62, Madison, IN.

Cash / Self-Pay

$39

Average discount available for prompt cash payment at this facility.

Insurance Median

$152

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$33.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $33.73 (100%)

Cash / Self-Pay: $39 (116%)

Insurance Median: $152 (451%)

Cash: $39 (116% of Medicare)

Ins. Median: $152 (451% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $33.73 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 451% of the Medicare baseline (a markup of 351%). 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
Aetna	$20 - $158	59%
Blue Cross Blue Shield	$20 - $59	59%
Humana	$20 - $32	59%
Managed Health Services Of Kentucky	$20	59%
Passport By Molina	$20	59%
UnitedHealthcare	$32 - $141	95%
Managed Health Services	$33 - $49	98%
Caresource Of Kentucky	$44	130%
Caresource Of Indiana	$48	142%
Custom Design Benefits	$63 - $90	187%
Cigna	$144 - $153	427%
Encore	$144 - $153	427%
Quality Care Partners	$151 - $160	448%
Bluegrass	$153 - $162	454%
First Health	$153 - $162	454%
Healthlink	$153 - $162	454%
Vha/Tristate	$153 - $162	454%
Multiplan/Phcs	$156 - $166	462%
Indiana Health Network	$162 - $171	480%
Siho	$162 - $171	480%

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 $39.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97750.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Norton-King's Daughters' Health is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97750.
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.