go back

Physical Therapy Evaluation, High Complexity

Illinois 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 July 2026.

How much does Physical Therapy Evaluation, High Complexity cost?

$83.18

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $83.18 for this service. The price depends on where it is billed: about $83.18 from a physician practice, and about $155 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 6 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$83.18$69.18 to $100
FacilityA hospital or hospital-owned outpatient department$155$97.72 to $275

How much rates vary

Facilitymedian $155 · 10th to 90th $81 to $398Professionalmedian $83 · 10th to 90th $58 to $126
$50.0$100.0$200.0$500.0$1.0Kfacility $155professional $83

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
$81.28
Median
$141.25
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$75.86
Typical High
$117.49
BCBS
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$218.78
Typical High
$776.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$100.00
Typical High
$102.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$112.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$81.28
Typical High
$154.88
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$141.25
Typical High
$288.40
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$131.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$107.15
Typical High
$162.18
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$87.10
Typical High
$151.36

Where Illinois sits

The same service costs 2.6 times more in Alaska than in Delaware. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Illinois $83.18 · 23rd of 51
AK $170DE $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.