CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Norton-King's Daughters' Health

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $171
Cash Discount Price: $43
vs. Medicare Baseline: 5.88x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Norton-King's Daughters' Health is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $43. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 5.88x the Medicare baseline. Located in 1373 East Sr 62, Madison, IN.

Cash / Self-Pay

$43

Average discount available for prompt cash payment at this facility.

Insurance Median

$171

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $43 (148%)

Insurance Median: $171 (588%)

Cash: $43 (148% of Medicare)

Ins. Median: $171 (588% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $29.06 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 588% of the Medicare baseline (a markup of 488%). 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	$18 - $178	62%
Blue Cross Blue Shield	$18 - $57	62%
Humana	$18 - $28	62%
Managed Health Services Of Kentucky	$18	62%
Passport By Molina	$18	62%
Managed Health Services	$28 - $43	96%
UnitedHealthcare	$28 - $159	96%
Caresource Of Kentucky	$39	134%
Caresource Of Indiana	$41	141%
Custom Design Benefits	$55 - $101	189%
Cigna	$162 - $172	557%
Encore	$162 - $172	557%
Quality Care Partners	$170 - $180	585%
Bluegrass	$172 - $182	592%
First Health	$172 - $182	592%
Healthlink	$172 - $182	592%
Vha/Tristate	$172 - $182	592%
Multiplan/Phcs	$176 - $186	606%
Indiana Health Network	$181 - $192	623%
Siho	$181 - $192	623%

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 $43.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97110.

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 97110.
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.