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South Carolina 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 $93 · 10th–90th $71–$2450%10%20%10th90th$93Professionalmedian $85 · 10th–90th $58–$2090%10%10th90th$85$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
$70.79 / $93.33 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $85.11 / $213.80
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$89.13 / $144.54 / $144.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $151.36 / $323.59
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $74.13 / $114.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $54.95 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $69.18 / $102.33
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $83.18 / $138.04
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $77.62 / $97.72