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Physical Therapy Evaluation, High Complexity

West 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 July 2026.

How much does Physical Therapy Evaluation, High Complexity cost?

$112

Typical negotiated rate. In West Virginia, July 2026.

Insurers have agreed to pay about $112 for this service. The price depends on where it is billed: about $112 from a physician practice, and about $102 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$112$77.62 to $209
FacilityA hospital or hospital-owned outpatient department$102$93.33 to $162

How much rates vary

Facilitymedian $102 · 10th to 90th $93 to $490Professionalmedian $112 · 10th to 90th $59 to $214
$50.0$100.0$200.0$500.0facility $102professional $112

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
$93.33
Median
$93.33
Typical High
$489.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$117.49
Typical High
$213.80
CareSource
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$102.33
Typical High
$123.03
CareSource
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$97.72
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$162.18
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$117.49
Typical High
$467.74
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$100.00
Typical High
$154.88
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$85.11
Typical High
$144.54
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$87.10
Typical High
$131.83

Where West Virginia 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.

West Virginia $112 · 5th 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.