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Occupational Therapy Evaluation, Moderate Complexity

Iowa 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?

$97.72

Typical negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $97.72 for this service. The price depends on where it is billed: about $97.72 from a physician practice, and about $115 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 8 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$97.72$70.79 to $155
FacilityA hospital or hospital-owned outpatient department$115$95.50 to $186

How much rates vary

Facilitymedian $115 · 10th to 90th $63 to $347Professionalmedian $98 · 10th to 90th $63 to $331
$50$100$200$500facility $115professional $98

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
$63.10
Median
$181.97
Typical High
$346.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$91.20
Typical High
$331.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$64.57
Typical High
$109.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$109.65
Typical High
$154.88
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$134.90
Typical High
$245.47
Medica
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$109.65
Typical High
$467.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$104.71
Typical High
$281.84
Midlands
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$154.88
Typical High
$288.40
Midlands
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$109.65
Midlands
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$131.83
Typical High
$204.17
United
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$87.10
Typical High
$162.18
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$151.36

Where Iowa 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.

Iowa· 12th of 51

$97.72

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.