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Physical Therapy Evaluation, Lower Complexity

Delaware 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?

$66.07

Typical negotiated rate. In Delaware, July 2026.

Insurers have agreed to pay about $66.07 for this service. The price depends on where it is billed: about $66.07 from a physician practice, and about $97.72 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 4 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$66.07$56.23 to $77.62
FacilityA hospital or hospital-owned outpatient department$97.72$63.10 to $102

How much rates vary

Facilitymedian $98 · 10th to 90th $63 to $102Professionalmedian $66 · 10th to 90th $49 to $95
$50$100$200facility $98professional $66

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
$63.10
Median
$97.72
Typical High
$102.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$64.57
Typical High
$89.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$83.18
Typical High
$112.20
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
United
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$104.71
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$89.13
Typical High
$194.98

Where Delaware 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.

Delaware· 51st of 51

$66.07

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.