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Physical Therapy Evaluation, Lower Complexity

Illinois 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 Illinois, July 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $79.43 from a physician practice, and about $162 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 7 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$79.43$67.61 to $100
FacilityA hospital or hospital-owned outpatient department$162$97.72 to $245

How much rates vary

Facilitymedian $162 · 10th to 90th $81 to $398Professionalmedian $79 · 10th to 90th $58 to $135
$50$100$200$500$1Kfacility $162professional $79

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
$81.28
Median
$147.91
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$75.86
Typical High
$128.82
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
BCBS
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$213.80
Typical High
$645.65
BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$100.00
Typical High
$102.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$112.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$81.28
Typical High
$154.88
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$141.25
Typical High
$218.78
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$131.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$107.15
Typical High
$162.18
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$91.20
Typical High
$162.18

Where Illinois 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.

Illinois· 31st 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.