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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 October 2026.

How much does Physical Therapy Evaluation, High Complexity cost?

$83.18

Typical negotiated rate. In Illinois, October 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.

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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$83.18$81.28 to $100
FacilityA hospital or hospital-owned outpatient department$155$117 to $269

How much rates vary

Facilitymedian $155 · 10th to 90th $98 to $661Professionalmedian $83 · 10th to 90th $74 to $105
$50$100$200$500$1Kfacility $155professional $83

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
$72.44
Median
$117.49
Typical High
$194.98
Aetna
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$81.28
Typical High
$87.10
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$34.67
Median
$40.74
Typical High
$40.74
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$131.83
Median
$190.55
Typical High
$776.25
BCBS Illinois
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$83.18
Typical High
$100.00
Cigna
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$83.18
Typical High
$147.91
Hally Health
Setting
Professional
Modifier
None
Typical Low
$93.33
Median
$134.90
Typical High
$204.17
Hally Health
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$123.03
Typical High
$131.83
Molina
Setting
Professional
Modifier
None
Typical Low
$33.11
Median
$33.11
Typical High
$33.11
United
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$117.49
United
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$77.62
Typical High
$134.90
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
Ambetter
Setting
Professional
Modifier
GP · Physical therapy plan
Typical Low
$70.79
Median
$75.86
Typical High
$100.00

Where Illinois 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.

Illinois· 29th of 51

$83.18

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.