go back

Physical Therapy Evaluation, Lower Complexity

South Carolina rates for HCPCS 97161

This is an initial evaluation by a physical therapist for a condition involving a limited number of body areas and a fairly stable or predictable clinical picture. The therapist reviews the patient's history, examines movement and function, and creates a plan of care. It's typically used for straightforward cases rather than complex or evolving conditions.

Rates data updated July 2026.

How much does Physical Therapy Evaluation, Lower Complexity cost?

$83.18

Typical negotiated rate. In South Carolina, July 2026.

Insurers have agreed to pay about $83.18 for this service. The price depends on where it is billed: about $83.18 from a physician practice, and about $112 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$83.18$69.18 to $110
FacilityA hospital or hospital-owned outpatient department$112$70.79 to $209

How much rates vary

Facilitymedian $112 · 10th to 90th $69 to $282Professionalmedian $83 · 10th to 90th $59 to $166
$50$100$200facility $112professional $83

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$117.49
Typical High
$251.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$83.18
Typical High
$165.96
BCBS
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$173.78
Typical High
$354.81
BCBS
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$51.29
Typical High
$109.65
Cigna
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$54.95
Typical High
$120.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$70.79
Typical High
$107.15
Medcost
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$83.18
Typical High
$138.04
Medcost
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$97.72
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$77.62
Typical High
$104.71

Where South Carolina sits

The same service costs 3.2 times more in West Virginia than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Carolina· 28th of 51

$83.18

WV $209DE $66.07

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.