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Occupational Therapy Evaluation, Moderate Complexity

Maryland 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?

$75.86

Typical negotiated rate. In Maryland, July 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $87.10 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$74.13$63.10 to $93.33
FacilityA hospital or hospital-owned outpatient department$87.10$74.13 to $148

How much rates vary

Facilitymedian $87 · 10th to 90th $58 to $447Professionalmedian $74 · 10th to 90th $56 to $135
$100.0$1.0K$10.0K$100.0Kfacility $87professional $74

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
$57.54
Median
$87.10
Typical High
$446.68
Aetna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$72.44
Typical High
$181.97
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$91.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$181.97
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$85.11
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$107.15
Typical High
$151.36
United
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$69.18
Typical High
$87.10
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$93.33
Typical High
$112.20
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$104.71
Typical High
$154.88

Where Maryland 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.

Maryland $75.86 · 38th 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.