go back

Physical Therapy Evaluation, Lower Complexity

Maryland 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?

$79.43

Typical negotiated rate. In Maryland, July 2026.

Insurers have agreed to pay about $79.43 for this service. The price depends on where it is billed: about $79.43 from a physician practice, and about $97.72 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$79.43$63.10 to $105
FacilityA hospital or hospital-owned outpatient department$97.72$74.13 to $389

How much rates vary

Facilitymedian $98 · 10th to 90th $58 to $589Professionalmedian $79 · 10th to 90th $56 to $251
$50$100$200$500$1Kfacility $98professional $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
$57.54
Median
$100.00
Typical High
$588.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$77.62
Typical High
$288.40
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$97.72
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$181.97
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$83.18
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$104.71
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$70.79
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$91.20
Typical High
$120.23
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$102.33
Typical High
$154.88

Where Maryland 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.

Maryland· 37th of 51

$79.43

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.