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Occupational Therapy Evaluation, Moderate Complexity

Maine 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?

$91.20

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $91.20 for this service. The price depends on where it is billed: about $85.11 from a physician practice, and about $126 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$85.11$61.66 to $126
FacilityA hospital or hospital-owned outpatient department$126$95.50 to $178

How much rates vary

Facilitymedian $126 · 10th to 90th $95 to $339Professionalmedian $85 · 10th to 90th $48 to $195
$50$200$1K$5Kfacility $126professional $85

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
$95.50
Median
$125.89
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$66.07
Typical High
$95.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$102.33
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$109.65
Typical High
$234.42
Community Health Options
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$338.84
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$134.90
Typical High
$208.93
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$123.03
Typical High
$177.83
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$79.43
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$109.65
Typical High
$199.53

Where Maine 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.

Maine· 19th of 51

$91.20

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.