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Physical Therapy Evaluation, Lower Complexity

New Jersey 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?

$77.62

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $77.62 for this service. The price depends on where it is billed: about $75.86 from a physician practice, and about $200 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$75.86$63.10 to $105
FacilityA hospital or hospital-owned outpatient department$200$91.20 to $339

How much rates vary

Facilitymedian $200 · 10th to 90th $58 to $724Professionalmedian $76 · 10th to 90th $50 to $126
$50$100$200$500$1Kfacility $200professional $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
$57.54
Median
$199.53
Typical High
$724.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$75.86
Typical High
$114.82
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$75.86
Typical High
$120.23
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$114.82
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$77.62
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$87.10
Typical High
$97.72
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$75.86
Typical High
$114.82

Where New Jersey 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.

New Jersey· 41st of 51

$77.62

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.