CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Norton-King's Daughters' Health

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $132
Cash Discount Price: $33
vs. Medicare Baseline: 4.03x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Norton-King's Daughters' Health is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.03x the Medicare baseline. Located in 1373 East Sr 62, Madison, IN.

Cash / Self-Pay

$33

Average discount available for prompt cash payment at this facility.

Insurance Median

$132

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: $33 (101%)

Insurance Median: $132 (403%)

Cash: $33 (101% of Medicare)

Ins. Median: $132 (403% 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 403% of the Medicare baseline (a markup of 303%). 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	$21 - $137	64%
Blue Cross Blue Shield	$21 - $56	64%
Humana	$21 - $31	64%
Managed Health Services Of Kentucky	$21	64%
Passport By Molina	$21	64%
UnitedHealthcare	$31 - $122	95%
Managed Health Services	$32 - $48	98%
Caresource Of Kentucky	$43	131%
Caresource Of Indiana	$46	141%
Custom Design Benefits	$61 - $78	186%
Cigna	$125 - $133	382%
Encore	$125 - $133	382%
Quality Care Partners	$131 - $139	400%
Bluegrass	$132 - $140	403%
First Health	$132 - $140	403%
Healthlink	$132 - $140	403%
Vha/Tristate	$132 - $140	403%
Multiplan/Phcs	$135 - $144	412%
Indiana Health Network	$140 - $148	428%
Siho	$140 - $148	428%

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 $33.
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 Norton-King's Daughters' Health 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.