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Occupational Therapy Evaluation, High Complexity

Ohio 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 July 2026.

How much does Occupational Therapy Evaluation, High Complexity cost?

$74.13

Typical physician fee. In Ohio, July 2026.

Insurers have agreed to pay about $74.13 for this service. Most negotiated rates run $60.26 to $95.50.

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.

How much rates vary

Professionalmedian $74 · 10th to 90th $54 to $129
$50$100$200professional $74

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$66.07
Typical High
$107.15
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$85.11
Typical High
$144.54
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$100.00
Typical High
$128.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$91.20
Typical High
$154.88
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$91.20
Typical High
$154.88
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$77.62
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$117.49
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$79.43
Typical High
$109.65

Where Ohio sits

The same service costs 2.8 times more in Alaska than in Kentucky. 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.

Ohio· 39th of 51

$74.13

AK $186KY $66.07

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.