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Physical Therapy Evaluation, High Complexity

Rhode Island 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?

$74.13

Typical negotiated rate. In Rhode Island, July 2026.

Insurers have agreed to pay about $74.13 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $219 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 4 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$60.26 to $77.62
FacilityA hospital or hospital-owned outpatient department$219$182 to $525

How much rates vary

Facilitymedian $219 · 10th to 90th $148 to $525Professionalmedian $74 · 10th to 90th $49 to $91
$20.0$100.0$500.0$2.0K$10.0Kfacility $219professional $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. 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
Global
Typical Low
$524.81
Median
$524.81
Typical High
$524.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$74.13
Typical High
$77.62
BCBS
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$204.17
Typical High
$12,302.69
BCBS
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$100.00
Typical High
$100.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$75.86
Typical High
$141.25
United
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$83.18
Typical High
$125.89

Where Rhode Island 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.

Rhode Island $74.13 · 43rd 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.