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Occupational Therapy Evaluation, High Complexity

Connecticut 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?

$74.13

Typical negotiated rate. In Connecticut, October 2026.

Insurers have agreed to pay about $74.13 for this service. The price depends on where it is billed: about $72.44 from a physician practice, and about $214 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$72.44$66.07 to $85.11
FacilityA hospital or hospital-owned outpatient department$214$166 to $282

How much rates vary

Facilitymedian $214 · 10th to 90th $129 to $331Professionalmedian $72 · 10th to 90th $65 to $102
$100$200facility $214professional $72

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
$102.33
Median
$169.82
Typical High
$389.05
Aetna
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$70.79
Typical High
$74.13
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$30.20
Median
$35.48
Typical High
$35.48
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$151.36
Median
$213.80
Typical High
$331.13
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$64.57
Median
$75.86
Typical High
$97.72
Cigna
Setting
Professional
Modifier
None
Typical Low
$66.07
Median
$85.11
Typical High
$123.03
ConnectiCare
Setting
Facility
Modifier
None
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
ConnectiCare
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$107.15
Typical High
$109.65
Health New England
Setting
Facility
Modifier
None
Typical Low
$257.04
Median
$257.04
Typical High
$263.03
United
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$85.11
Typical High
$120.23

Where Connecticut 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.

Connecticut· 45th of 51

$74.13

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.