go back

Physical Therapy Evaluation, Lower Complexity

Missouri 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?

$85.11

Typical negotiated rate. In Missouri, July 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $83.18 from a physician practice, and about $107 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$83.18$66.07 to $174
FacilityA hospital or hospital-owned outpatient department$107$77.62 to $151

How much rates vary

Facilitymedian $107 · 10th to 90th $71 to $245Professionalmedian $83 · 10th to 90th $55 to $331
$50$100$200$500$1K$2Kfacility $107professional $83

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
$70.79
Median
$107.15
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$87.10
Typical High
$346.74
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$56.23
Typical High
$141.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$104.71
Typical High
$162.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$91.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$79.43
Typical High
$186.21
Medica
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$97.72
Typical High
$223.87
Medica
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$83.18
Typical High
$630.96
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$144.54
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$81.28
Typical High
$138.04

Where Missouri 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.

Missouri· 24th of 51

$85.11

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.