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Physical Therapy Evaluation, Lower Complexity

Ohio 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?

$81.28

Typical negotiated rate. In Ohio, July 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $77.62 from a physician practice, and about $141 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 9 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$77.62$60.26 to $105
FacilityA hospital or hospital-owned outpatient department$141$102 to $182

How much rates vary

Facilitymedian $141 · 10th to 90th $66 to $263Professionalmedian $78 · 10th to 90th $55 to $209
$50$100$200$500facility $141professional $78

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
$58.88
Median
$123.03
Typical High
$251.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$70.79
Typical High
$213.80
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$89.13
Typical High
$147.91
Aultcare
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$131.83
Typical High
$131.83
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$81.28
Typical High
$190.55
CareSource
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$95.50
Typical High
$125.89
CareSource
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$97.72
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$141.25
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$83.18
Typical High
$158.49
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$186.21
Typical High
$309.03
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$87.10
Typical High
$151.36
Medical Mutual of Ohio
Setting
Professional
Modifier
CQ · PT assistant
Typical Low
$134.90
Median
$134.90
Typical High
$134.90
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$79.43
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$104.71
Typical High
$154.88
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$97.72
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$77.62
Typical High
$128.82

Where Ohio 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.

Ohio· 32nd of 51

$81.28

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.