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Physical Therapy Evaluation, Lower Complexity

Kentucky 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?

$74.13

Typical negotiated rate. In Kentucky, July 2026.

Insurers have agreed to pay about $74.13 for this service. The price depends on where it is billed: about $69.18 from a physician practice, and about $81.28 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$69.18$58.88 to $91.20
FacilityA hospital or hospital-owned outpatient department$81.28$81.28 to $120

How much rates vary

Facilitymedian $81 · 10th to 90th $66 to $178Professionalmedian $69 · 10th to 90th $54 to $120
$50$100$200$500facility $81professional $69

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
$107.15
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$74.13
Typical High
$128.82
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$120.23
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$63.10
Typical High
$79.43
CareSource
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$109.65
Typical High
$134.90
CareSource
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$109.65
Typical High
$138.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$162.18
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$104.71
Typical High
$467.74
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$48.98
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$75.86
Typical High
$117.49

Where Kentucky 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.

Kentucky· 48th of 51

$74.13

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.