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Occupational Therapy Evaluation, High Complexity

Rhode Island 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?

$83.18

Typical physician fee. In Rhode Island, October 2026.

Insurers have agreed to pay about $83.18 for this service. Most negotiated rates run $74.13 to $105.

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 4 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $214 · 10th to 90th $141 to $12,303Professionalmedian $81 · 10th to 90th $72 to $107
$100$200$500$1K$2K$5K$10Kfacility $214professional $81

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
Professional
Modifier
None
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$37.15
Median
$37.15
Typical High
$37.15
BCBS Rhode Island
Setting
Facility
Modifier
None
Typical Low
$151.36
Median
$218.78
Typical High
$12,302.69
BCBS Rhode Island
Setting
Professional
Modifier
None
Typical Low
$72.44
Median
$104.71
Typical High
$104.71
BCBS Rhode Island
Setting
Professional
Modifier
EP · Child screening program
Typical Low
$162.18
Median
$234.42
Typical High
$234.42
Cigna
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$107.15
Typical High
$138.04
United
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
United
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$85.11
Typical High
$120.23

Where Rhode Island 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.

Rhode Island· 31st of 51

$83.18

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.