Physical therapy evaluation (moderate complexity) Cost

Physical therapy evaluation (moderate complexity) is a therapy or rehabilitation service. Prices are from 2382 US hospitals across 52 states, from their machine-readable files.

$234median cash price · 2382 hospitals, 52 statestypically $100–$570 depending on the hospital
≈ 2.4× Medicare · On the higher sideFind hospitals near you

Price comparison (median)

Chargemaster (list price)
$387
Cash / self-pay
$234
Insurer-negotiated
$164
Medicare pays
$98
$100$570
Median cash $234  ·  Medicare $98  ·  bar = typical cash range (10th–90th percentile)
Is this a fair price?
1× Medicarefair ≈2×5×+

Typical cash price here is $234 — about 2.4× the Medicare rate ($98). On the higher side. A fair cash price is usually within ~2× Medicare ($196).

💡 Asking for the cash price instead of the $387 list price could save about $153 (40%).

Estimate what you’ll pay
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Rough estimate from this procedure’s median insurer-negotiated rate. Your actual cost depends on your plan — confirm with your insurer.

Lowest cash prices

HospitalLocationCashInsurerCMS ratingER waitReadmit
Banner Payson Medical Center Payson, AZ $35 $77 ★ 4/5 142 min —
University of Ks Hlth System Great Bend Campus Great Bend, KS $40 $121 ★ 4/5 107 min —
Winn Parish Medical Center Winnfield, LA $42 $93 — 100 min —
Banner-University Medical Center South Campus Tucson, AZ $42 $127 ★ 4/5 260 min —
Ochsner LSU Health Monroe Monroe, LA $42 $92 ★ 3/5 152 min —
Bayamon Medical Center Bayamon, PR $43 $20 — 279 min —
East Jefferson General Hospital Metairie, LA $44 $74 ★ 2/5 157 min —
Seton Medical Center Harker Heights Harker Heights, TX $46 $179 ★ 4/5 174 min —
Ochsner St Mary Morgan City, LA $47 $95 ★ 2/5 89 min —
Ochsner LSU Health Shreveport-St Mary Medical Cent Shreveport, LA $47 $95 ★ 2/5 — —
Clinch Memorial Hospital Homerville, GA $48 $91 — 94 min —
Slidell Memorial Hospital Slidell, LA $49 $92 ★ 2/5 203 min —
King's Daughters Medical Center-Brookhaven Brookhaven, MS $49 $123 ★ 3/5 140 min —
Clarke County Hospital Osceola, IA $50 $65 ★ 5/5 104 min —
Virtua Our Lady of Lourdes Hospital Camden, NJ $50 — ★ 2/5 168 min —
Virtua Willingboro Hospital Willingboro, NJ $50 — ★ 3/5 178 min —
Bsa Hospital Amarillo, TX $50 $349 ★ 2/5 215 min —
Saint Vincent Hospital Erie, PA $51 $97 ★ 4/5 219 min —
Eisenhower Medical Center Rancho Mirage, CA $51 $103 ★ 4/5 259 min —
Hamilton Medical Center Dalton, GA $52 — ★ 3/5 181 min —
Baptist Health Medical Center-Arkadelphia Arkadelphia, AR $52 $175 — 94 min —
Baptist Health Medical Center Heber Springs Heber Springs, AR $52 $175 ★ 3/5 110 min —
Sabine Medical Center Many, LA $53 $93 — 129 min —
Tanner Medical Center-East Alabama Wedowee, AL $53 $65 — 96 min —
University Medical Center of El Paso El Paso, TX $53 $116 ★ 3/5 240 min —

CMS rating = overall hospital star rating (1–5); ER wait = median minutes in the emergency department; Readmit = 30-day readmission rate (lower is better) — all from Medicare’s Care Compare; “—” = not reported. Data last updated October 2026. Prices from hospitals’ machine-readable files (45 CFR §180); Medicare benchmark from CMS PFS/CLFS/IPPS. Prices below 15% of the median are excluded as likely partial or mis-coded charges. Estimates — confirm with the hospital. Report an incorrect price.

What insurers pay for Physical therapy evaluation (moderate complexity)

Median in-network negotiated rate by insurer, across hospitals that publish it (cheapest first). Your actual rate depends on your specific plan and deductible. Cash / self-pay for comparison: $234; Medicare pays $98.

InsurerHospitalsNegotiated median
Univera 10
$84
$83 – $111
Medicaid 314
$89
$59 – $171
Tricare / VA 406
$91
$84 – $297
Independent Health 46
$91
$58 – $172
Highmark 121
$95
$84 – $303
Devoted Health 214
$97
$84 – $188
Medicare 535
$98
$89 – $171
Amerigroup 161
$98
$45 – $382
Centene / Ambetter 764
$101
$56 – $197
Humana 986
$101
$84 – $374
Molina Healthcare 536
$102
$60 – $208
AmeriHealth 243
$109
$59 – $444
Priority Health 53
$111
$66 – $293
Bright Health 49
$117
$89 – $222
Security Health Plan 59
$150
$94 – $299
Oscar Health 233
$151
$92 – $264
UCare 68
$155
$81 – $287
Anthem 545
$159
$63 – $411
UnitedHealthcare 1524
$163
$84 – $404
UPMC Health Plan 81
$168
$94 – $451
MVP Health Care 84
$174
$87 – $407
Aetna 1407
$180
$87 – $394
SelectHealth 44
$187
$94 – $373
Sanford Health Plan 68
$189
$98 – $306
HealthPartners 261
$200
$95 – $358
Blue Cross Blue Shield 1277
$202
$91 – $509
Medica 249
$204
$99 – $327
EmblemHealth 71
$222
$112 – $340
Healthcare Highways 40
$224
$119 – $389
Cigna 1162
$227
$96 – $491
Geisinger 62
$239
$85 – $470
Kaiser Permanente 159
$241
$98 – $1,002
AvMed 62
$244
$102 – $498
Health Net 280
$254
$103 – $648
Workers' Comp / No-Fault 149
$256
$80 – $581
Coventry 154
$257
$94 – $422
Harvard Pilgrim 50
$276
$146 – $377
MultiPlan / PHCS network 864
$333
$163 – $583

Negotiated rates are from hospitals’ machine-readable files (45 CFR §180); payer names are normalized to major brands, so a brand may span several plans. Estimates — confirm with your insurer.

Where it’s cheapest

StateMedian cash
Puerto Rico$43
Tennessee$115
Mississippi$118
Arizona$123
Alabama$123
Oklahoma$124

Prices by city

Chicago, ILPhiladelphia, PABaltimore, MDAustin, TXDallas, TXHouston, TXCincinnati, OHNew York, NYBrooklyn, NYKansas City, MOOklahoma City, OKSan Antonio, TXBaton Rouge, LABronx, NYCharlotte, NCCleveland, OHFort Worth, TXMilwaukee, WINashville, TNOmaha, NESacramento, CASaint Louis, MOAlbuquerque, NMBirmingham, AL

Prices by state

TexasCaliforniaOhioFloridaPennsylvaniaWisconsinNew YorkIllinoisMinnesotaNorth CarolinaMichiganLouisianaTennesseeGeorgiaMissouriIowaColoradoNebraskaOklahomaKansasNew JerseyVirginiaIndianaSouth DakotaArkansasMarylandKentuckyArizonaWashingtonMississippiMassachusettsMaineWest VirginiaAlabamaSouth CarolinaMontanaOregonNorth DakotaIdahoConnecticutNew MexicoNew HampshireUtahNevadaHawaiiWyomingVermontDelawareAlaskaRhode IslandPuerto RicoWashington DC

Doctors who perform this

Clinicians who reported the most Medicare volume for this service. This reflects Original Medicare activity only and is a volume signal, not a quality ranking.

ClinicianSpecialtyLocationMedicare services
Spencer ClarkPhysical Therapist in Private PracticeSalt Lake City, UT2,193
Ahson Mahfooz, PT, DPTPhysical Therapist in Private PracticeBrooklyn, NY821
Darrel ElwellPhysical Therapist in Private PracticeRoswell, NM671
Elizabeth Owens, DPTPhysical Therapist in Private PracticeColumbus, OH662
Tami Peavy, PTPhysical Therapist in Private PracticeAlhambra, CA589
John GamindePhysical Therapist in Private PracticeRichmond Hill, NY559
Juan Nunez, P.T.Physical Therapist in Private PracticePalmetto Bay, FL513
Mary Jean Endozo, PTPhysical Therapist in Private PracticePlainfield, NJ511
Fernando OrlinoPhysical Therapist in Private PracticeSan Diego, CA461
David Anthony, PHYSICAL THERAPISTPhysical Therapist in Private PracticePort Charlotte, FL461
Nicholas MalyPhysical Therapist in Private PracticeSanta Barbara, CA457
Mohamed Afify, PTPhysical Therapist in Private PracticeBrooklyn, NY432

Browse doctors by specialty & city →

Does Medicare cover Physical therapy evaluation (moderate complexity)?

Yes — Medicare generally covers Physical therapy evaluation (moderate complexity). It is typically an outpatient service under Medicare Part B, with a Medicare-approved amount of about $98. After your annual Part B deductible, you typically owe the 20% coinsurance — roughly $20 — unless a Medicare Advantage or supplemental (Medigap) plan covers it.

General guidance from Medicare’s national rates — your actual coverage and share depend on medical necessity, your plan, and where the service is performed. Confirm with Medicare or your plan.

About these prices

Based on prices published by 2382 US hospitals across 52 states, the typical (median) cash price is $234, versus a chargemaster (list) price around $387, a median insurer-negotiated rate of $164, a Medicare rate of about $98. Most cash prices fall between $100 and $570 — a wide spread, which is exactly why comparing hospitals pays off.

How to save

  • Ask each hospital for its cash / self-pay price — for shoppable services it is often far below the list price.
  • Compare several nearby hospitals; prices for the same service can differ severalfold.
  • Request a written estimate and the billing code (CPT/DRG) before scheduling.
  • Use the Medicare benchmark above to judge whether a quote is reasonable.
  • If you are uninsured, ask about financial assistance or prompt-pay discounts.

Frequently asked questions

How much does Physical therapy evaluation (moderate complexity) cost without insurance?
The median cash (self-pay) price across 2382 US hospitals is $234. Most hospitals fall between $100 and $570. Prices vary widely between hospitals, so it pays to compare before you book.
Does Medicare cover Physical therapy evaluation (moderate complexity)?
Yes — it is generally covered under Medicare Part B as an outpatient service (Medicare-approved amount about $98). After your Part B deductible you typically owe 20% coinsurance, unless a Medicare Advantage or Medigap plan covers it.
What does Medicare pay for Physical therapy evaluation (moderate complexity)?
Medicare pays about $98. We show this as a benchmark — a fair cash price is often within a few multiples of the Medicare rate.
Why do Physical therapy evaluation (moderate complexity) prices vary between hospitals?
Hospitals set their own chargemaster and cash prices and negotiate different rates with each insurer, so two hospitals in the same area can charge very differently for the same service.
Is the cash price lower than using insurance?
Sometimes. If you are uninsured or have a high deductible, the cash/self-pay price can be lower than the insurer-negotiated rate — ask the hospital for both.

Related Therapy & Rehab

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