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Physical Therapy Evaluation, High Complexity

North Carolina 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?

$77.62

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $77.62 for this service. The price depends on where it is billed: about $77.62 from a physician practice, and about $91.20 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 7 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$77.62$66.07 to $85.11
FacilityA hospital or hospital-owned outpatient department$91.20$83.18 to $148

How much rates vary

Facilitymedian $91 · 10th to 90th $76 to $240Professionalmedian $78 · 10th to 90th $58 to $135
$50.0$100.0$200.0$500.0facility $91professional $78

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
$83.18
Median
$100.00
Typical High
$257.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$77.62
Typical High
$131.83
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
BCBS
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$141.25
Typical High
$190.55
BCBS
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$75.86
Typical High
$128.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$77.62
Typical High
$141.25
Medcost
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$85.11
Typical High
$123.03
Medcost
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$89.13
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$81.28
Typical High
$125.89
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$831.76
Typical High
$831.76

Where North Carolina 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.

North Carolina $77.62 · 34th 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.