go back

Connecticut 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 $257 · 10th–90th $105–$4170%10%10th90th$257Professionalmedian $87 · 10th–90th $58–$1820%10%10th90th$87$20.0$50.0$100.0$200.0$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
$104.71 / $257.04 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $89.13 / $190.55
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $194.98 / $331.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $79.43 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $77.62 / $173.78
ConnectiCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
ConnectiCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $104.71 / $114.82
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $269.15 / $389.05
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $75.86 / $158.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $83.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $87.10 / $123.03