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Occupational Therapy Evaluation, Moderate Complexity

Illinois 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?

$83.18

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $83.18 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $148 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$81.28$69.18 to $100
FacilityA hospital or hospital-owned outpatient department$148$95.50 to $269

How much rates vary

Facilitymedian $148 · 10th to 90th $81 to $339Professionalmedian $81 · 10th to 90th $60 to $135
$50.0$100.0$200.0$500.0$1.0Kfacility $148professional $81

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
$81.28
Median
$138.04
Typical High
$323.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$74.13
Typical High
$104.71
BCBS
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$234.42
Typical High
$741.31
BCBS
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$100.00
Typical High
$123.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$109.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$87.10
Typical High
$158.49
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$144.54
Typical High
$208.93
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$134.90
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$109.65
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$85.11
Typical High
$154.88

Where Illinois 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.

Illinois $83.18 · 27th 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.