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Occupational Therapy Evaluation, High Complexity

Washington, DC rates for HCPCS 97167

This is a thorough evaluation performed by an occupational therapist to assess a patient's ability to perform daily activities, such as dressing, cooking, or work tasks, when the patient's condition involves multiple complicating factors. It typically includes a detailed history, standardized assessments, and clinical judgment to develop a treatment plan for a patient with a more complex presentation than a routine evaluation. This level reflects more time and clinical complexity than a basic evaluation.

Rates data updated October 2026.

How much does Occupational Therapy Evaluation, High Complexity cost?

$77.62

Typical physician fee. In Washington, DC, October 2026.

Insurers have agreed to pay about $77.62 for this service. Most negotiated rates run $75.86 to $85.11.

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.

How much rates vary

Facilitymedian $148 · 10th to 90th $78 to $269Professionalmedian $78 · 10th to 90th $74 to $105
$100$200facility $148professional $78

Distribution of negotiated rates across all payers (price axis is log-scale). 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
None
Typical Low
$77.62
Median
$147.91
Typical High
$269.15
Aetna
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$77.62
Typical High
$81.28
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$37.15
Median
$38.90
Typical High
$38.90
CareFirst
Setting
Professional
Modifier
None
Typical Low
$75.86
Median
$83.18
Typical High
$85.11
Cigna
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$79.43
Typical High
$141.25
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$112.20
Median
$112.20
Typical High
$181.97
United
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$104.71
Typical High
$263.03

Where Washington, DC sits

The same service costs 3.3 times more in Alaska than in Florida. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Washington, DC· 38th of 51

$77.62

AK $200FL $60.26

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.