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Physical Therapy Evaluation, Lower Complexity

North Dakota 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?

$95.50

Typical negotiated rate. In North Dakota, July 2026.

Insurers have agreed to pay about $95.50 for this service. The price depends on where it is billed: about $95.50 from a physician practice, and about $126 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 5 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 $204
FacilityA hospital or hospital-owned outpatient department$126$87.10 to $209

How much rates vary

Facilitymedian $126 · 10th to 90th $87 to $282Professionalmedian $95 · 10th to 90th $63 to $251
$100$200facility $126professional $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
$87.10
Median
$91.20
Typical High
$281.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$79.43
Typical High
$162.18
BCBS
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$218.78
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$107.15
Typical High
$112.20
Medica
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$131.83
Typical High
$316.23
Medica
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$141.25
Typical High
$234.42
United
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$91.20
Typical High
$251.19

Where North Dakota 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 Dakota· 17th of 51

$95.50

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.