go back

Occupational Therapy Evaluation, High Complexity

Vermont 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?

$112

Typical physician fee. In Vermont, October 2026.

Insurers have agreed to pay about $112 for this service. Most negotiated rates run $83.18 to $120.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $251 · 10th to 90th $204 to $257Professionalmedian $107 · 10th to 90th $83 to $129
$100$200facility $251professional $107

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
$251.19
Median
$251.19
Typical High
$251.19
Aetna
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$83.18
Typical High
$95.50
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$30.20
Median
$40.74
Typical High
$40.74
BCBS Vermont
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$204.17
Typical High
$269.15
BCBS Vermont
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$100.00
Typical High
$100.00
Cigna
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$120.23
Typical High
$120.23
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$125.89
Typical High
$371.54
United
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$114.82
Typical High
$128.82

Where Vermont 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.

Vermont· 13th of 51

$112

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.