go back

Occupational Therapy Evaluation, Moderate Complexity

Kentucky 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?

$70.79

Typical negotiated rate. In Kentucky, July 2026.

Insurers have agreed to pay about $70.79 for this service. The price depends on where it is billed: about $66.07 from a physician practice, and about $83.18 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$66.07$56.23 to $74.13
FacilityA hospital or hospital-owned outpatient department$83.18$83.18 to $123

How much rates vary

Facilitymedian $83 · 10th to 90th $66 to $166Professionalmedian $66 · 10th to 90th $47 to $95
$50.0$100.0$200.0$500.0facility $83professional $66

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
$66.07
Median
$104.71
Typical High
$478.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$66.07
Typical High
$104.71
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$123.03
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$61.66
Typical High
$75.86
CareSource
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$112.20
Typical High
$138.04
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$112.20
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$165.96
Typical High
$165.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$107.15
Typical High
$489.78
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$47.86
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$114.82
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$79.43
Typical High
$107.15

Where Kentucky 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.

Kentucky $70.79 · 49th 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.