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Physical Therapy Evaluation, High Complexity

New Jersey 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?

$75.86

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $234 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 5 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$74.13$63.10 to $93.33
FacilityA hospital or hospital-owned outpatient department$234$91.20 to $525

How much rates vary

Facilitymedian $234 · 10th to 90th $58 to $776Professionalmedian $74 · 10th to 90th $49 to $126
$50.0$100.0$200.0$500.0$1.0Kfacility $234professional $74

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
$57.54
Median
$234.42
Typical High
$776.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$66.07
Typical High
$112.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$75.86
Typical High
$120.23
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$114.82
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$77.62
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$87.10
Typical High
$97.72
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$75.86
Typical High
$114.82

Where New Jersey 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.

New Jersey $75.86 · 40th 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.