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Occupational Therapy Evaluation, Moderate Complexity

Georgia 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?

$77.62

Typical negotiated rate. In Georgia, July 2026.

Insurers have agreed to pay about $77.62 for this service. The price depends on where it is billed: about $75.86 from a physician practice, and about $178 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 7 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$75.86$66.07 to $93.33
FacilityA hospital or hospital-owned outpatient department$178$69.18 to $282

How much rates vary

Facilitymedian $178 · 10th to 90th $65 to $457Professionalmedian $76 · 10th to 90th $59 to $132
$50$100$200$500facility $178professional $76

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
$64.57
Median
$177.83
Typical High
$457.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$72.44
Typical High
$117.49
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$89.13
Typical High
$144.54
CareSource
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$100.00
Typical High
$131.83
CareSource
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$70.79
Typical High
$100.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$83.18
Typical High
$158.49
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$120.23
Typical High
$204.17
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$134.90
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$100.00
Typical High
$147.91
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$89.13
Typical High
$134.90

Where Georgia sits

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

Georgia· 34th of 51

$77.62

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.