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Physical Therapy Evaluation, Lower Complexity

Michigan 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?

$75.86

Typical negotiated rate. In Michigan, July 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $75.86 from a physician practice, and about $79.43 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 8 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$75.86$63.10 to $85.11
FacilityA hospital or hospital-owned outpatient department$79.43$75.86 to $129

How much rates vary

Facilitymedian $79 · 10th to 90th $76 to $191Professionalmedian $76 · 10th to 90th $58 to $107
$50$100$200facility $79professional $76

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
$75.86
Median
$79.43
Typical High
$190.55
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$75.86
Typical High
$107.15
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$83.18
BCBS
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$134.90
Typical High
$169.82
BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$87.10
Typical High
$87.10
CareSource
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$117.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$81.28
Typical High
$229.09
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$194.98
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$79.43
Typical High
$128.82
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$83.18
Typical High
$263.03
United
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$97.72
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$79.43
Typical High
$112.20

Where Michigan 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.

Michigan· 44th of 51

$75.86

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.