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Pennsylvania rates for HCPCS 97164

Re-evaluation of physical therapy established plan of care, requiring these components: An examination including a review of history and use of standardized tests and measures is required; and Revised plan of care using a 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 $81 · 10th–90th $47–$1660%10%20%10th90th$81Professionalmedian $54 · 10th–90th $40–$1700%20%10th90th$54$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$46.77 / $81.28 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $53.70 / $213.80
Aetna
Facility/Professional
Professional
Modifier
CQ
Typical Low / Median / Typical High
$69.18 / $69.18 / $69.18
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $64.57 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $75.86 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $61.66 / $112.20
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $34.67 / $109.65
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $75.86 / $120.23
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $169.82 / $194.98
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $60.26 / $60.26
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $67.61 / $102.33
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $52.48 / $107.15
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $89.13
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $41.69 / $89.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27.54 / $27.54 / $67.61
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $50.12 / $72.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $74.13 / $74.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $57.54 / $87.10