Price Checker / CPT 97167
How much does Ot Evaluation High Complex 60 Min cost?
CPT 97167 · Based on 2026 Medicare rates and hospital-published pricing
The average hospital charge is about 2.4x the fair price. You have grounds to ask for a reduction.
Fair price
$380–$450
What this should cost
With insurance
~$550
Typical out-of-pocket
Overcharged if over
$560
Push back above this
The average hospital charge of $1,015 is $595 over the fair price (about 2.4x the fair rate).
What hospitals charge for Ot Evaluation High Complex 60 Min
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Baylor Scott & White Texas Spine and Joint Hospital Tyler, TX | — | — | 8723% |
| Rehabilitation Hospital of Rhode Island , RI | $7,470 | $7,470 | 7330% |
| UM Shore Medical Center at Cambridge , MD | $1,826 | — | 1716% |
| UM Upper Chesapeake Behavior Health Pavilion at Aberdeen , MD | $1,816 | — | 1706% |
| HealthSource Saginaw SAGINAW, MI | — | — | 1690% |
| UM Capital Region Medical Center Largo, MD | $1,530 | — | 1421% |
| UM Rehabilitation & Orthopaedic Institute Baltimore, MD | $1,220 | — | 1114% |
| UM Shore Medical Center at Chestertown Chestertown, MD | $1,103 | — | 997% |
| MEDICAL CITY MENTAL HEALTH AND WELLNESS CENTER - ALLIANCE FORT WORTH, TX | $1,098 | — | 993% |
| UM Upper Chesapeake Medical Center Aberdeen Aberdeen, MD | $973 | — | 868% |
| Penn Medicine Good Shepherd Rehabilitation Specialty Hospital , PA | $791 | — | 529% |
| Baptist Health Rehabilitation Institute-Little Rock , AR | $471 | $118 | 368% |
| Covenant Rehabilitation Hospital of Lubbock, LLC Lubbock, TX | $260 | — | 206% |
| Harmon Hospital Las Vegas, NV | $300 | — | 198% |
| Summa Rehab Hospital, LLC Akron, OH | $260 | — | 144% |
Were you billed for this procedure?
Send us your bill and we'll compare every line item against Medicare rates and your hospital's published prices. Free review, no obligation.
About Ot Evaluation High Complex 60 Min
CPT code 97167 refers to ot evaluation high complex 60 min (billing description: "Ot eval high complex 60 min"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $101 in a facility (hospital or surgery center) and $101 in a doctor's office.
The Medicare rate is the closest thing to an objective "what this work is actually worth." A fair cash price for the uninsured is generally 1.5–3x that rate. Hospital sticker (gross) charges are often far higher — but almost nobody actually pays them.
What to do if you were overcharged
- 1Send us your bill — we'll identify this code and compare it against the rates shown above.
- 2Get a dispute letter — citing the Medicare rate and your hospital's own published pricing data.
- 3We negotiate for you — 25% of savings, no savings = no fee.