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Physical Therapy Evaluation, High Complexity

Iowa rates for HCPCS 97163

A physical therapist assesses a person's movement, strength, and physical function to understand how an injury or condition is limiting them, then develops a plan of care. This version applies to more complicated cases, involving a more extensive health history and a higher number of factors affecting movement and function than a simpler evaluation.

Rates data updated October 2026.

How much does Physical Therapy Evaluation, High Complexity cost?

$120

Typical negotiated rate. In Iowa, October 2026.

Insurers have agreed to pay about $120 for this service. The price depends on where it is billed: about $120 from a physician practice, and about $151 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$120$83.18 to $141
FacilityA hospital or hospital-owned outpatient department$151$107 to $174

How much rates vary

Facilitymedian $151 · 10th to 90th $98 to $209Professionalmedian $120 · 10th to 90th $65 to $174
$100$200$500facility $151professional $120

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$64.57
Median
$128.82
Typical High
$223.87
Aetna
Setting
Professional
Modifier
None
Typical Low
$64.57
Median
$64.57
Typical High
$100.00
Cigna
Setting
Facility
Modifier
None
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Cigna
Setting
Professional
Modifier
None
Typical Low
$89.13
Median
$128.82
Typical High
$158.49
Hally Health
Setting
Professional
Modifier
None
Typical Low
$102.33
Median
$125.89
Typical High
$173.78
Medica
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$151.36
Typical High
$204.17
Medica
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$125.89
Typical High
$630.96
Midlands
Setting
Professional
Modifier
None
Typical Low
$109.65
Median
$109.65
Typical High
$154.88
Midlands
Setting
Professional
Modifier
None
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$134.90
Typical High
$199.53
United
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$169.82
United
Setting
Professional
Modifier
None
Typical Low
$64.57
Median
$83.18
Typical High
$131.83
Wellmark
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$120.23
Typical High
$147.91
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$32.36
Median
$32.36
Typical High
$47.86

Where Iowa sits

The same service costs 3.3 times more in Alaska than in Florida. 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.

Iowa· 8th of 51

$120

AK $200FL $60.26

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.