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Occupational Therapy Evaluation, Moderate Complexity

North Carolina 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?

$85.11

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $89.13 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$81.28$67.61 to $87.10
FacilityA hospital or hospital-owned outpatient department$89.13$85.11 to $138

How much rates vary

Facilitymedian $89 · 10th to 90th $71 to $158Professionalmedian $81 · 10th to 90th $60 to $158
$50.0$100.0$200.0$500.0facility $89professional $81

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
$85.11
Median
$87.10
Typical High
$158.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$77.62
Typical High
$165.96
BCBS
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$112.20
Typical High
$199.53
BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$87.10
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$77.62
Typical High
$138.04
Medcost
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$85.11
Typical High
$128.82
Medcost
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$87.10
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$81.28
Typical High
$117.49
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$630.96
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$851.14
Typical High
$851.14

Where North Carolina 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.

North Carolina $85.11 · 24th 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.