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Physical Therapy Evaluation, Lower Complexity

Maine 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?

$91.20

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $91.20 for this service. The price depends on where it is billed: about $87.10 from a physician practice, and about $129 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$87.10$60.26 to $120
FacilityA hospital or hospital-owned outpatient department$129$95.50 to $170

How much rates vary

Facilitymedian $129 · 10th to 90th $91 to $282Professionalmedian $87 · 10th to 90th $49 to $191
$50$200$1K$5Kfacility $129professional $87

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
$91.20
Median
$128.82
Typical High
$281.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$63.10
Typical High
$91.20
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$102.33
Typical High
$190.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$60.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$107.15
Typical High
$229.09
Community Health Options
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$338.84
Community Health Options
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$123.03
Typical High
$204.17
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$131.83
Typical High
$204.17
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$123.03
Typical High
$281.84
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$91.20
Typical High
$144.54
United
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$112.20
Typical High
$213.80

Where Maine 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.

Maine· 21st of 51

$91.20

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.