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Physical Therapy Evaluation, Lower Complexity

Vermont 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?

$97.72

Typical negotiated rate. In Vermont, July 2026.

Insurers have agreed to pay about $97.72 for this service. The price depends on where it is billed: about $97.72 from a physician practice, and about $302 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$97.72$75.86 to $112
FacilityA hospital or hospital-owned outpatient department$302$263 to $324

How much rates vary

Facilitymedian $302 · 10th to 90th $234 to $407Professionalmedian $98 · 10th to 90th $59 to $120
$50$100$200facility $302professional $98

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$302.00
Typical High
$323.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$97.72
Typical High
$120.23
BCBS
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$288.40
Typical High
$407.38
BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$107.15
Typical High
$120.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$89.13
Typical High
$144.54
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$123.03
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$112.20
Typical High
$199.53

Where Vermont 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.

Vermont· 15th of 51

$97.72

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.