Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
Top Providers in Washington
| Provider | Medicare | Services |
|---|---|---|
| Guardia, Mary OTR/L,CHT | $55.61 | 23 |
Washington Pricing in Context
In Washington, CPT code 97168 (Re-Evaluation For Occupational Therapy, Typically 30 Minutes) carries an average Medicare payment of $52.86 — 3% below the national benchmark of $54.27. 106 providers across the state submitted claims for this procedure in 2023, performing 598 total services. Individual payments in WA ranged from N/A at the low end to N/A at the high end, reflecting differences in provider setting (office vs. facility), modifiers, and the specific geographic locality code applied within the state.
The average billed charge in Washington is $122.53, which is the figure uninsured patients would most likely encounter before any negotiation or charity discount. Medicare, by statute, only reimburses the allowed amount — the balance between billed and paid is written off under provider participation agreements. Insured patients generally pay a negotiated rate that falls between these two figures; the exact amount depends on plan design, deductible status, and in-network participation. Because Washington sits below the national Medicare average, commercial rates in the state may also run lower than the US median.
Using RAND 2024 commercial-to-Medicare ratios for Medicine procedures, the estimated commercial insurance price in Washington lands near $165.28, with self-pay cash prices typically around $86.44. Before scheduling, patients can request a Good Faith Estimate under the No Surprises Act, compare cash rates from hospital Machine-Readable Files, and confirm whether the provider is in-network with their specific plan. This page presents CMS reference data for informational use; it does not constitute medical or financial advice.
Frequently Asked Questions
How much does Re-Evaluation For Occupational Therapy, Typically 30 Minutes cost in Washington?
The average Medicare payment for Re-Evaluation For Occupational Therapy, Typically 30 Minutes in Washington is $52.86, which is 3% below the national average of $54.27. Providers in WA typically bill $122.53 for this procedure.
What does Re-Evaluation For Occupational Therapy, Typically 30 Minutes cost with insurance in Washington?
With commercial insurance in Washington, Re-Evaluation For Occupational Therapy, Typically 30 Minutes costs an estimated $165.28. Without insurance, the estimated cash price is $86.44. These estimates are based on RAND 2024 commercial-to-Medicare ratios and vary by insurer, plan, and facility.
How many providers perform Re-Evaluation For Occupational Therapy, Typically 30 Minutes in Washington?
106 providers in Washington billed Medicare for Re-Evaluation For Occupational Therapy, Typically 30 Minutes in 2023, performing 598 total services. Medicare payments ranged from N/A to N/A depending on the provider.
Is Re-Evaluation For Occupational Therapy, Typically 30 Minutes cheaper in Washington than the national average?
Yes — Re-Evaluation For Occupational Therapy, Typically 30 Minutes costs 3% below the national average in Washington. The state average Medicare payment is $52.86 compared to $54.27 nationally. Factors like local cost of living, provider competition, and regional Medicare fee schedules all influence state-level pricing.
Related Guides
Related Data Sources
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology — how this data is sourced, computed, and verified.