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Physical Therapy Evaluation, Lower Complexity

Georgia 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?

$81.28

Typical negotiated rate. In Georgia, July 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $93.33 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$81.28$66.07 to $105
FacilityA hospital or hospital-owned outpatient department$93.33$70.79 to $214

How much rates vary

Facilitymedian $93 · 10th to 90th $66 to $282Professionalmedian $81 · 10th to 90th $58 to $135
$50$100$200$500facility $93professional $81

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
$66.07
Median
$93.33
Typical High
$281.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$79.43
Typical High
$134.90
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$162.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$85.11
Typical High
$138.04
CareSource
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$97.72
Typical High
$128.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$70.79
Typical High
$97.72
Cigna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$81.28
Typical High
$158.49
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$97.72
Typical High
$144.54
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$251.19
Typical High
$407.38
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$131.83
Typical High
$141.25
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$97.72
Typical High
$144.54
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$83.18
Typical High
$138.04

Where Georgia 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.

Georgia· 30th of 51

$81.28

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.