Price Checker / CPT 97161
How much does Pt Evaluation Low Complex 20 Min cost?
CPT 97161 · Based on 2026 Medicare rates and hospital-published pricing
The average hospital charge is roughly 6.1x the fair price. This is well above fair — push back or dispute it.
Fair price
$330–$390
What this should cost
With insurance
~$540
Typical out-of-pocket
Overcharged if over
$490
Push back above this
The average hospital charge of $2,192 is $1,832 over the fair price (about 6.1x the fair rate).
What hospitals charge for Pt Evaluation Low Complex 20 Min
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Phelps Hospital SLEEPY HOLLOW, NY | — | $367 | 26038% |
| South Shore University Hospital , NY | — | $367 | 25756% |
| Bladen County Hospital , NC | $244 | — | 6849% |
| Hoke Hospital , NC | $244 | — | 6849% |
| UM Capital Region Medical Center Largo, MD | $3,216 | — | 3186% |
| University of Maryland Medical Center Baltimore, MD | $3,094 | — | 3062% |
| UM Shore Medical Center at Easton Easton, MD | $2,497 | — | 2452% |
| UM Upper Chesapeake Behavior Health Pavilion at Aberdeen , MD | $1,957 | — | 1900% |
| UM Shore Medical Center at Chestertown Chestertown, MD | $1,874 | — | 1815% |
| HealthSource Saginaw SAGINAW, MI | — | — | 1739% |
| University of Maryland Medical Center - Midtown Campus BALTIMORE, MD | $1,775 | — | 1714% |
| UM R Adams Cowley Shock Trauma Center Baltimore, MD | $1,587 | — | 1522% |
| UM Rehabilitation & Orthopaedic Institute Baltimore, MD | $1,366 | — | 1296% |
| UM Baltimore Washington Medical Center Glen Burnie, MD | $1,320 | — | 1249% |
| UM Upper Chesapeake Medical Center Aberdeen Aberdeen, MD | $1,259 | — | 1187% |
Were you billed for this procedure?
Send us your bill and we'll compare every line item against Medicare rates and your hospital's published prices. Free review, no obligation.
About Pt Evaluation Low Complex 20 Min
CPT code 97161 refers to pt evaluation low complex 20 min (billing description: "Pt eval low complex 20 min"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $98 in a facility (hospital or surgery center) and $98 in a doctor's office.
The Medicare rate is the closest thing to an objective "what this work is actually worth." A fair cash price for the uninsured is generally 1.5–3x that rate. Hospital sticker (gross) charges are often far higher — but almost nobody actually pays them.
What to do if you were overcharged
- 1Send us your bill — we'll identify this code and compare it against the rates shown above.
- 2Get a dispute letter — citing the Medicare rate and your hospital's own published pricing data.
- 3We negotiate for you — 25% of savings, no savings = no fee.