go back

Occupational Therapy Evaluation, High Complexity

Iowa 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?

$123

Typical negotiated rate. In Iowa, October 2026.

Insurers have agreed to pay about $123 for this service. The price depends on where it is billed: about $123 from a physician practice, and about $145 from a hospital or other facility.

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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$123$87.10 to $138
FacilityA hospital or hospital-owned outpatient department$145$110 to $162

How much rates vary

Facilitymedian $145 · 10th to 90th $95 to $214Professionalmedian $123 · 10th to 90th $68 to $174
$100$200$500facility $145professional $123

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$131.83
Typical High
$229.09
Aetna
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$100.00
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$33.11
Median
$33.11
Typical High
$50.12
Cigna
Setting
Facility
Modifier
None
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Cigna
Setting
Professional
Modifier
None
Typical Low
$89.13
Median
$131.83
Typical High
$158.49
Hally Health
Setting
Professional
Modifier
None
Typical Low
$104.71
Median
$128.82
Typical High
$204.17
Medica
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$147.91
Typical High
$194.98
Medica
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$128.82
Typical High
$630.96
Midlands
Setting
Professional
Modifier
None
Typical Low
$112.20
Median
$112.20
Typical High
$158.49
Midlands
Setting
Professional
Modifier
None
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$138.04
Typical High
$204.17
United
Setting
Facility
Modifier
None
Typical Low
$109.65
Median
$109.65
Typical High
$173.78
United
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$87.10
Typical High
$125.89
Wellmark
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$123.03
Typical High
$151.36

Where Iowa 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.

Iowa· 9th of 51

$123

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.