go back

Physical Therapy Evaluation, Lower Complexity

Connecticut 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?

$75.86

Typical negotiated rate. In Connecticut, July 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $275 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$74.13$58.88 to $87.10
FacilityA hospital or hospital-owned outpatient department$275$178 to $389

How much rates vary

Facilitymedian $275 · 10th to 90th $105 to $417Professionalmedian $74 · 10th to 90th $49 to $115
$50$100$200$500facility $275professional $74

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
$102.33
Median
$275.42
Typical High
$457.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$70.79
Typical High
$114.82
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$223.87
Typical High
$331.13
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$81.28
Typical High
$123.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$79.43
Typical High
$177.83
ConnectiCare
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$109.65
Typical High
$114.82
Health New England
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$269.15
Typical High
$389.05
Health New England
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$75.86
Typical High
$158.49
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$83.18
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$87.10
Typical High
$123.03

Where Connecticut 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.

Connecticut· 45th of 51

$75.86

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.