go back

Physical Therapy Evaluation, High Complexity

Virginia 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?

$77.62

Typical negotiated rate. In Virginia, October 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 $105 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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$77.62$67.61 to $85.11
FacilityA hospital or hospital-owned outpatient department$105$77.62 to $166

How much rates vary

Facilitymedian $105 · 10th to 90th $59 to $437Professionalmedian $78 · 10th to 90th $59 to $93
$100$200$500$1K$2K$5K$10Kfacility $105professional $78

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
$56.23
Median
$77.62
Typical High
$147.91
Aetna
Setting
Professional
Modifier
None
Typical Low
$56.23
Median
$66.07
Typical High
$79.43
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$28.18
Median
$28.18
Typical High
$38.90
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$75.86
Typical High
$93.33
CareFirst
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$87.10
Typical High
$87.10
Cigna
Setting
Facility
Modifier
None
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Cigna
Setting
Professional
Modifier
None
Typical Low
$61.66
Median
$77.62
Typical High
$117.49
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$87.10
Median
$109.65
Typical High
$128.82
Medcost
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Medcost
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$154.88
Sentara
Setting
Facility
Modifier
None
Typical Low
$72.44
Median
$120.23
Typical High
$10,232.93
Sentara
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$81.28
Typical High
$162.18
United
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
United
Setting
Professional
Modifier
None
Typical Low
$61.66
Median
$75.86
Typical High
$107.15

Where Virginia 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.

Virginia· 37th of 51

$77.62

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.