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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 October 2026.

How much does Occupational Therapy Evaluation, Moderate Complexity cost?

$95.50

Typical negotiated rate. In Maine, October 2026.

Insurers have agreed to pay about $95.50 for this service. The price depends on where it is billed: about $95.50 from a physician practice, and about $95.50 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$95.50$83.18 to $112
FacilityA hospital or hospital-owned outpatient department$95.50$95.50 to $126

How much rates vary

Facilitymedian $95 · 10th to 90th $95 to $145Professionalmedian $95 · 10th to 90th $79 to $132
$100$200$500$1K$2K$5K$10Kfacility $95professional $95

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$95.50
Median
$95.50
Typical High
$128.82
Aetna
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$87.10
Typical High
$162.18
Cigna
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$112.20
Typical High
$199.53
Community Health Options
Setting
Facility
Modifier
None
Typical Low
$338.84
Median
$338.84
Typical High
$338.84
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$125.89
Typical High
$125.89
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$95.50
Median
$120.23
Typical High
$144.54
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Martin's Point
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
United
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$112.20
Typical High
$112.20

Where Maine sits

The same service costs 3.3 times more in Alaska than in Florida. 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

$95.50

AK $200FL $60.26

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.