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Physical Therapy Evaluation, Lower Complexity

South Dakota 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?

$97.72

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $97.72 for this service. The price depends on where it is billed: about $97.72 from a physician practice, and about $141 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 8 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$97.72$70.79 to $123
FacilityA hospital or hospital-owned outpatient department$141$102 to $214

How much rates vary

Facilitymedian $141 · 10th to 90th $87 to $245Professionalmedian $98 · 10th to 90th $63 to $174
$100$200facility $141professional $98

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
$89.13
Median
$120.23
Typical High
$173.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$72.44
Typical High
$104.71
Avera
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$120.23
Typical High
$131.83
Avera
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$128.82
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$107.15
Typical High
$109.65
Medica
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$162.18
Typical High
$257.04
Medica
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$120.23
Typical High
$213.80
Midlands
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$125.89
Typical High
$141.25
Midlands
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$177.83
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$144.54
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$85.11
Typical High
$199.53
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$131.83
Typical High
$154.88

Where South Dakota 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 Dakota· 16th of 51

$97.72

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.