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Occupational Therapy Evaluation, High Complexity

Maine 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?

$95.50

Typical physician fee. In Maine, October 2026.

Insurers have agreed to pay about $95.50 for this service. Most negotiated rates run $87.10 to $112.

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 7 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $95 · 10th to 90th $95 to $14,454Professionalmedian $95 · 10th to 90th $79 to $138
$100$200$500$1K$2K$5K$10Kfacility $95professional $95

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
$95.50
Median
$95.50
Typical High
$123.03
Aetna
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$87.10
Typical High
$162.18
Cigna
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$112.20
Typical High
$199.53
Community Health Options
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$120.23
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$125.89
Typical High
$125.89
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$123.03
Median
$123.03
Typical High
$14,454.40
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Martin's Point
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
United
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$112.20
Typical High
$112.20

Where Maine 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.

Maine· 19th of 51

$95.50

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.