go back

Physical Therapy Evaluation, Lower Complexity

Virginia 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 Virginia, July 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $95.50 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$64.57 to $105
FacilityA hospital or hospital-owned outpatient department$95.50$72.44 to $132

How much rates vary

Facilitymedian $95 · 10th to 90th $58 to $191Professionalmedian $81 · 10th to 90th $56 to $166
$50$200$1K$5Kfacility $95professional $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
$56.23
Median
$87.10
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$77.62
Typical High
$208.93
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$87.10
Typical High
$123.03
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$95.50
Typical High
$199.53
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$79.43
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$85.11
Typical High
$151.36
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$104.71
Typical High
$128.82
Medcost
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Medcost
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$83.18
Typical High
$128.82
Medcost
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Sentara
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$100.00
Typical High
$371.54
Sentara
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$100.00
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$107.15
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$85.11
Typical High
$117.49

Where Virginia 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.

Virginia· 29th 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.