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Physical Therapy Evaluation, Lower Complexity

Iowa 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 negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $110 for this service. The price depends on where it is billed: about $107 from a physician practice, and about $117 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$107$70.79 to $288
FacilityA hospital or hospital-owned outpatient department$117$100 to $224

How much rates vary

Facilitymedian $117 · 10th to 90th $63 to $457Professionalmedian $107 · 10th to 90th $63 to $347
$50$100$200$500facility $117professional $107

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
$177.83
Typical High
$295.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$104.71
Typical High
$371.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$64.57
Typical High
$112.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$107.15
Typical High
$158.49
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$131.83
Typical High
$213.80
Medica
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$125.89
Typical High
$239.88
Medica
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$120.23
Typical High
$263.03
Midlands
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$151.36
Typical High
$302.00
Midlands
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
Midlands
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$660.69
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$125.89
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$85.11
Typical High
$204.17
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$147.91

Where Iowa 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.

Iowa· 9th 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.