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Physical Therapy Evaluation, Lower Complexity

New Mexico 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?

$87.10

Typical negotiated rate. In New Mexico, July 2026.

Insurers have agreed to pay about $87.10 for this service. The price depends on where it is billed: about $83.18 from a physician practice, and about $145 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$63.10 to $115
FacilityA hospital or hospital-owned outpatient department$145$95.50 to $661

How much rates vary

Facilitymedian $145 · 10th to 90th $76 to $1,096Professionalmedian $83 · 10th to 90th $48 to $316
$100$1K$10K$100Kfacility $145professional $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
$114.82
Median
$144.54
Typical High
$173.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$79.43
Typical High
$331.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$707.95
Typical High
$1,230.27
BCBS
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$93.33
Typical High
$109.65
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$75.86
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$95.50
Typical High
$144.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$154.88
Providence
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$85.11
Typical High
$114.82
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$95.50
Typical High
$144.54
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$97.72
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$87.10
Typical High
$128.82

Where New Mexico 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 Mexico· 23rd of 51

$87.10

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.