Where therapists actually earn the most
California pays the highest median wage in four of these five professions. After state income tax and cost of living, it is not the best state for any of them.
After-tax pay adjusted for cost of living. Stacks state tax and local prices.
Shading is scaled within physical therapists only. US median for physical therapists: $102,760.
Alaska
#1 of 51 · Real value- BLS reported median
- $115,280
- State income tax
- none
- After-tax
- $115,280
- Cost of living (US = 100)
- 102.4
- Real value
- $112,623
Every experience level and setting, in one number.
See what you should be getting paidThese are state medians
Your local number depends on your experience and practice setting.
See what you should be getting paidRanked by profession
Highest median wage, and where that wage is worth the most after state income tax and cost of living. Full 51-state tables on each page.
Physical therapists
- Pays the most
- California $124,190
- Worth the most
- Alaska $112,623
California ranks #15 of 51 after adjustment.
All 51 states
Occupational therapists
- Pays the most
- California $124,510
- Worth the most
- Arkansas $117,815
California ranks #7 of 51 after adjustment.
All 51 states
Speech-language pathologists
- Pays the most
- California $118,970
- Worth the most
- Nevada $104,532
California ranks #5 of 51 after adjustment.
All 51 states
Physical therapist assistants
- Pays the most
- California $83,110
- Worth the most
- Texas $80,365
California ranks #7 of 51 after adjustment.
All 51 states
Occupational therapy assistants
- Pays the most
- Maryland $82,010
- Worth the most
- Arkansas $87,505
Maryland ranks #8 of 50 after adjustment.
All 50 states
Why the five lists disagree
Assistant pay sits in a much narrower band than therapist pay: the spread between the best and worst paying state is smaller in dollars, so a difference in cost of living moves an assistant ranking further than it moves a therapist ranking. That is why a state can be mid-pack for physical therapists and top five for physical therapist assistants, and why sharing one list across five professions would be wrong rather than merely imprecise.
How this is calculated
Nominal pay is the median annual wage from the U.S. Bureau of Labor Statistics Occupational Employment and Wage Statistics program (May 2025 release), for each profession in each state: physical therapists (SOC 29-1123), occupational therapists (SOC 29-1122), speech-language pathologists (SOC 29-1127), physical therapist assistants (SOC 31-2021), occupational therapy assistants (SOC 31-2011). Where BLS suppresses an estimate for confidentiality, that state is left out rather than filled in: the only gap today is COTA pay in Vermont.
Take-homesubtracts modeled state income tax for a single filer taking the standard deduction, at that state's median wage, using Tax Foundation brackets as of January 1, 2026. It does not include federal income tax or FICA (those don't vary by state, so they don't change the ranking), and it excludes local (city or county) income taxes.
Real valuedivides take-home by each state's cost of living, using the Bureau of Economic Analysis Regional Price Parities (2024), where the US average is 100. Cost of living already captures sales tax and, through rents, some property tax; income tax is separate, which is why it is applied on its own.
Limits: single filer only; local income taxes (Maryland, New York, Ohio) are averaged out at the state grain; and cost of living is statewide, so a specific metro can run higher or lower. Typical pay, not personalized tax advice.
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