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Physical Therapy Evaluation, High Complexity

Vermont 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?

$69.18

Typical negotiated rate. In Vermont, July 2026.

Insurers have agreed to pay about $69.18 for this service. The price depends on where it is billed: about $69.18 from a physician practice, and about $288 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$69.18$60.26 to $85.11
FacilityA hospital or hospital-owned outpatient department$288$234 to $324

How much rates vary

Facilitymedian $288 · 10th to 90th $112 to $324Professionalmedian $69 · 10th to 90th $49 to $107
$50.0$100.0$200.0$500.0facility $288professional $69

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
$323.59
Median
$323.59
Typical High
$323.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$69.18
Typical High
$85.11
BCBS
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$263.03
Typical High
$288.40
BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$107.15
Typical High
$120.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$89.13
Typical High
$144.54
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$123.03
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$112.20
Typical High
$199.53

Where Vermont 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.

Vermont $69.18 · 50th 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.