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Occupational Therapy Evaluation, Moderate Complexity

Michigan 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 Michigan, 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 $79.43 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$74.13$64.57 to $81.28
FacilityA hospital or hospital-owned outpatient department$79.43$75.86 to $138

How much rates vary

Facilitymedian $79 · 10th to 90th $76 to $209Professionalmedian $74 · 10th to 90th $55 to $93
$50.0$100.0$200.0$500.0facility $79professional $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
$75.86
Median
$79.43
Typical High
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$72.44
Typical High
$89.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$141.25
Typical High
$181.97
BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$93.33
Typical High
$93.33
CareSource
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$120.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$81.28
Typical High
$234.42
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$199.53
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$77.62
Typical High
$125.89
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$87.10
Typical High
$269.15
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$100.00
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$79.43
Typical High
$109.65

Where Michigan 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.

Michigan $75.86 · 37th 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.