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Physical Therapy Evaluation, Lower Complexity

North Carolina 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?

$83.18

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $83.18 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $100 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$81.28$66.07 to $95.50
FacilityA hospital or hospital-owned outpatient department$100$83.18 to $141

How much rates vary

Facilitymedian $100 · 10th to 90th $78 to $209Professionalmedian $81 · 10th to 90th $59 to $195
$50$100$200$500facility $100professional $81

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
$83.18
Median
$123.03
Typical High
$213.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$83.18
Typical High
$218.78
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
BCBS
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$114.82
Typical High
$190.55
BCBS
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$75.86
Typical High
$128.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$77.62
Typical High
$141.25
Medcost
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$85.11
Typical High
$123.03
Medcost
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$89.13
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$81.28
Typical High
$125.89
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$831.76
Typical High
$831.76

Where North Carolina 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.

North Carolina· 25th of 51

$83.18

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.