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Physical Therapy Evaluation, High Complexity

Maine 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?

$91.20

Typical physician fee. In Maine, October 2026.

Insurers have agreed to pay about $91.20 for this service. Most negotiated rates run $83.18 to $112.

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.

How much rates vary

Facilitymedian $91 · 10th to 90th $91 to $141Professionalmedian $91 · 10th to 90th $81 to $135
$100$200$500$1K$2K$5K$10Kfacility $91professional $91

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$91.20
Median
$91.20
Typical High
$125.89
Aetna
Setting
Professional
Modifier
None
Typical Low
$87.10
Median
$91.20
Typical High
$91.20
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$45.71
Median
$45.71
Typical High
$45.71
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$87.10
Typical High
$158.49
Cigna
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$112.20
Typical High
$194.98
Community Health Options
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$117.49
Typical High
$117.49
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$87.10
Median
$120.23
Typical High
$120.23
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$91.20
Median
$117.49
Typical High
$141.25
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Martin's Point
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$45.71
Median
$45.71
Typical High
$45.71
United
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$102.33
Typical High
$112.20

Where Maine 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.

Maine· 19th of 51

$91.20

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.