go back

Physical Therapy Evaluation, Lower Complexity

Indiana 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 Indiana, July 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $170 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 6 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$74.13$60.26 to $87.10
FacilityA hospital or hospital-owned outpatient department$170$95.50 to $240

How much rates vary

Facilitymedian $170 · 10th to 90th $71 to $263Professionalmedian $74 · 10th to 90th $55 to $138
$50$100$200facility $170professional $74

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
$74.13
Median
$186.21
Typical High
$263.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$131.83
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$81.28
Typical High
$102.33
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$79.43
Typical High
$141.25
CareSource
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$104.71
Typical High
$128.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$112.20
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$100.00
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$93.33
Typical High
$151.36
United
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$107.15
Typical High
$144.54
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$79.43
Typical High
$125.89

Where Indiana 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.

Indiana· 34th 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.