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Physical Therapy Evaluation, Lower Complexity

Montana 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?

$100

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $100 for this service. The price depends on where it is billed: about $95.50 from a physician practice, and about $170 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$95.50$77.62 to $158
FacilityA hospital or hospital-owned outpatient department$170$129 to $174

How much rates vary

Facilitymedian $170 · 10th to 90th $87 to $195Professionalmedian $95 · 10th to 90th $59 to $316
$100$1K$10K$100Kfacility $170professional $95

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
$107.15
Median
$173.78
Typical High
$229.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$81.28
Typical High
$331.13
Aetna
Setting
Professional
Modifier
CQ · PT assistant
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64,565.42
Median
$75,857.76
Typical High
$91,201.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$158.49
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$109.65
Typical High
$158.49
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$169.82
Typical High
$177.83
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$169.82
Typical High
$177.83
Providence
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$87.10
Typical High
$186.21
Providence
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$102.33
Typical High
$190.55
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$87.10
Typical High
$138.04

Where Montana 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.

Montana· 14th of 51

$100

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.