Evaluation for physical therapy, typically 45 minutes
Medicare pricing data for 36,109 providers across 52 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Evaluation for physical therapy, typically 45 minutes (HCPCS code 97163) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $100.11, but hospitals typically charge $191.68 — a 1.9x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $100.11, your out-of-pocket cost would be approximately $20.02. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 1.9x more than what Medicare allows for this procedure. Medicare actually pays $74.50 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $127 | $262 | 154 | 947 | +27.1% |
| District of Columbia | $109 | $204 | 76 | 341 | +8.7% |
| California | $108 | $166 | 3,356 | 32,237 | +7.6% |
| New Jersey | $107 | $214 | 1,748 | 11,839 | +6.8% |
| New York | $107 | $181 | 2,178 | 15,762 | +6.6% |
| Massachusetts | $106 | $220 | 750 | 5,581 | +5.8% |
| Connecticut | $105 | $178 | 356 | 2,003 | +5.2% |
| Maryland | $105 | $225 | 1,113 | 10,583 | +5.0% |
| Hawaii | $105 | $152 | 184 | 1,399 | +5.0% |
| Rhode Island | $104 | $170 | 138 | 836 | +4.1% |
| Washington | $103 | $196 | 1,262 | 8,074 | +2.7% |
| Colorado | $102 | $177 | 1,064 | 7,182 | +1.4% |
| Delaware | $101 | $244 | 246 | 3,797 | +1.2% |
| Illinois | $101 | $230 | 1,919 | 17,801 | +1.2% |
| New Hampshire | $101 | $209 | 191 | 1,142 | +0.5% |
| North Dakota | $100 | $204 | 55 | 183 | +0.3% |
| Pennsylvania | $100 | $184 | 1,420 | 12,089 | +0.3% |
| Virginia | $100 | $172 | 1,082 | 8,298 | +0.2% |
| Montana | $99 | $172 | 295 | 2,231 | -0.6% |
| Nevada | $99 | $234 | 364 | 3,176 | -0.9% |
| Minnesota | $99 | $251 | 489 | 1,992 | -1.1% |
| South Dakota | $99 | $184 | 116 | 730 | -1.2% |
| Vermont | $99 | $182 | 84 | 467 | -1.2% |
| Wyoming | $99 | $171 | 190 | 1,329 | -1.4% |
| Oregon | $98 | $206 | 682 | 3,968 | -1.6% |
| Florida | $98 | $205 | 1,480 | 14,730 | -1.8% |
| Maine | $98 | $181 | 232 | 1,319 | -2.0% |
| Michigan | $98 | $203 | 1,310 | 9,852 | -2.1% |
| Arizona | $98 | $187 | 888 | 7,732 | -2.3% |
| Texas | $97 | $188 | 1,780 | 15,443 | -2.6% |
| Wisconsin | $97 | $269 | 903 | 4,956 | -3.5% |
| Indiana | $95 | $221 | 701 | 7,220 | -4.7% |
| Ohio | $95 | $185 | 667 | 4,179 | -4.9% |
| Utah | $95 | $140 | 349 | 4,082 | -4.9% |
| Nebraska | $95 | $192 | 270 | 1,623 | -5.0% |
| South Carolina | $95 | $178 | 675 | 8,269 | -5.0% |
| Iowa | $95 | $181 | 536 | 2,852 | -5.2% |
| North Carolina | $95 | $202 | 1,050 | 6,120 | -5.6% |
| Idaho | $94 | $146 | 349 | 2,638 | -6.3% |
| Louisiana | $94 | $171 | 376 | 2,929 | -6.3% |
| Kansas | $94 | $161 | 393 | 2,757 | -6.4% |
| Georgia | $94 | $168 | 1,049 | 6,941 | -6.5% |
| Missouri | $94 | $170 | 526 | 3,419 | -6.6% |
| Puerto Rico | $93 | $103 | 19 | 171 | -7.0% |
| Kentucky | $92 | $175 | 458 | 3,330 | -7.7% |
| Oklahoma | $92 | $172 | 373 | 2,572 | -7.8% |
| Alabama | $92 | $188 | 407 | 2,903 | -7.8% |
| New Mexico | $92 | $162 | 205 | 2,366 | -8.3% |
| West Virginia | $92 | $144 | 154 | 1,038 | -8.6% |
| Tennessee | $91 | $164 | 884 | 6,566 | -8.7% |
| Arkansas | $90 | $163 | 262 | 1,999 | -9.7% |
| Mississippi | $89 | $158 | 262 | 1,774 | -11.0% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber