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Physical Therapy Evaluation, Lower Complexity

West 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?

$209

Typical negotiated rate. In West Virginia, July 2026.

Insurers have agreed to pay about $209 for this service. The price depends on where it is billed: about $209 from a physician practice, and about $93.33 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$209$93.33 to $214
FacilityA hospital or hospital-owned outpatient department$93.33$93.33 to $102

How much rates vary

Facilitymedian $93 · 10th to 90th $93 to $162Professionalmedian $209 · 10th to 90th $69 to $214
$100$200facility $93professional $209

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
$93.33
Median
$93.33
Typical High
$123.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$208.93
Typical High
$213.80
CareSource
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$102.33
Typical High
$123.03
CareSource
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$97.72
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$162.18
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$117.49
Typical High
$467.74
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$93.33
Typical High
$97.72
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$85.11
Typical High
$144.54
United
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$87.10
Typical High
$131.83

Where West 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.

West Virginia· 1st of 51

$209

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.