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Occupational Therapy Evaluation, Moderate Complexity

Connecticut rates for HCPCS 97166

An occupational therapist assesses how a health condition, injury, or developmental issue is affecting a person's ability to perform everyday tasks like dressing, cooking, or working, then creates a plan of care. This version reflects a moderately complex case, with a somewhat more involved health history and a moderate number of areas affecting daily function compared to a more straightforward evaluation.

Rates data updated July 2026.

How much does Occupational Therapy Evaluation, Moderate Complexity cost?

$75.86

Typical negotiated rate. In Connecticut, July 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $302 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$74.13$60.26 to $89.13
FacilityA hospital or hospital-owned outpatient department$302$170 to $347

How much rates vary

Facilitymedian $302 · 10th to 90th $102 to $407Professionalmedian $74 · 10th to 90th $54 to $115
$50.0$100.0$200.0$500.0facility $302professional $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
Facility
Modifier
Global
Typical Low
$102.33
Median
$316.23
Typical High
$407.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$70.79
Typical High
$100.00
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$213.80
Typical High
$316.23
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$79.43
Typical High
$123.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$91.20
Typical High
$186.21
ConnectiCare
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$107.15
Typical High
$109.65
Health New England
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$269.15
Typical High
$389.05
Health New England
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$85.11
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$89.13
Typical High
$117.49

Where Connecticut sits

The same service costs 2.8 times more in Alaska than in Delaware. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Connecticut $75.86 · 39th of 51
AK $182DE $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.