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South Carolina rates for HCPCS 97162

Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.

Facilitymedian $95 · 10th–90th $71–$2750%10%20%10th90th$95Professionalmedian $79 · 10th–90th $55–$1660%10%10th90th$79$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
$70.79 / $95.50 / $275.42
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $79.43 / $169.82
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $165.96 / $338.84
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
$58.88 / $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