go back

Physical Therapy Evaluation, High Complexity

Missouri 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?

$63.10

Typical negotiated rate. In Missouri, October 2026.

Insurers have agreed to pay about $63.10 for this service. The price depends on where it is billed: about $61.66 from a physician practice, and about $110 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$61.66$48.98 to $100
FacilityA hospital or hospital-owned outpatient department$110$97.72 to $191

How much rates vary

Facilitymedian $110 · 10th to 90th $72 to $457Professionalmedian $62 · 10th to 90th $45 to $170
$50$100$200$500facility $110professional $62

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
$69.18
Median
$102.33
Typical High
$123.03
Aetna
Setting
Professional
Modifier
None
Typical Low
$58.88
Median
$72.44
Typical High
$91.20
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$41.69
Median
$51.29
Typical High
$165.96
BCBS Kansas City
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$104.71
Typical High
$109.65
Cigna
Setting
Professional
Modifier
None
Typical Low
$37.15
Median
$63.10
Typical High
$169.82
Medica
Setting
Facility
Modifier
None
Typical Low
$91.20
Median
$134.90
Typical High
$457.09
Medica
Setting
Professional
Modifier
None
Typical Low
$58.88
Median
$85.11
Typical High
$630.96
United
Setting
Facility
Modifier
None
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
United
Setting
Professional
Modifier
None
Typical Low
$58.88
Median
$74.13
Typical High
$138.04
2 more rates 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
$34.67
Median
$36.31
Typical High
$41.69
Ambetter
Setting
Professional
Modifier
GP · Physical therapy plan
Typical Low
$72.44
Median
$72.44
Typical High
$75.86

Where Missouri 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.

Missouri· 50th of 51

$63.10

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.