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Physical Therapy Evaluation, Lower Complexity

Hawaii 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?

$110

Typical physician fee. In Hawaii, July 2026.

Insurers have agreed to pay about $110 for this service. Most negotiated rates run $83.18 to $126.

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.

How much rates vary

Facilitymedian $138 · 10th to 90th $135 to $427Professionalmedian $110 · 10th to 90th $65 to $186
$100$200facility $138professional $110

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$138.04
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$97.72
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$102.33
Typical High
$131.83
HMSA
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$120.23
Typical High
$147.91
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$120.23
Typical High
$134.90
United
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$100.00
Typical High
$141.25
University Health Alliance
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$128.82
Typical High
$251.19

Where Hawaii 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.

Hawaii· 8th of 51

$110

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.