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Arizona rates for HCPCS 97161

Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.

Facilitymedian $174 · 10th–90th $78–$4170%10%10th90th$174Professionalmedian $95 · 10th–90th $58–$2820%5%10%10th90th$95$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $194.98 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $95.50 / $288.40
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$85.11 / $85.11 / $144.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $218.78 / $489.78
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $77.62 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $57.54 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $93.33 / $158.49
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $97.72 / $223.87
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $87.10 / $199.53
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $112.20 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $87.10 / $131.83