Occupational Therapy Evaluation, Moderate Complexity

Delaware 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?

$66.07

Typical negotiated rate. In Delaware, July 2026.

Insurers have agreed to pay about $66.07 for this service. The price depends on where it is billed: about $66.07 from a physician practice, and about $64.57 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 3 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed by	Who charges it	Typical	Range
Physician practiceA doctor's office, clinic or independent provider	A doctor's office, clinic or independent provider	$66.07	$52.48 to $77.62
FacilityA hospital or hospital-owned outpatient department	A hospital or hospital-owned outpatient department	$64.57	$63.10 to $105

How much rates vary

Facilitymedian $65 · 10th to 90th $63 to $105Professionalmedian $66 · 10th to 90th $48 to $95

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	Facility/Professional	Modifier	Typical Low	Median	Typical High
Aetna Setting Facility Modifier Global Typical Low $63.10 Median $63.10 Typical High $104.71	Facility	Global	$63.10	$63.10	$104.71
Aetna Setting Professional Modifier Global Typical Low $47.86 Median $64.57 Typical High $77.62	Professional	Global	$47.86	$64.57	$77.62
Cigna Setting Facility Modifier Global Typical Low $64.57 Median $64.57 Typical High $64.57	Facility	Global	$64.57	$64.57	$64.57
Cigna Setting Professional Modifier Global Typical Low $60.26 Median $93.33 Typical High $114.82	Professional	Global	$60.26	$93.33	$114.82
United Setting Facility Modifier Global Typical Low $104.71 Median $104.71 Typical High $104.71	Facility	Global	$104.71	$104.71	$104.71
United Setting Professional Modifier Global Typical Low $64.57 Median $89.13 Typical High $208.93	Professional	Global	$64.57	$89.13	$208.93

Where Delaware 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.

Delaware $66.07 · 51st 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.