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?
$81.28
Typical physician fee. In New Jersey, October 2026.
Insurers have agreed to pay about $81.28 for this service. Most negotiated rates run $56.23 to $83.18.
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.
How much rates vary
Facilitymedian $56 · 10th to 90th $45 to $263Professionalmedian $81 · 10th to 90th $56 to $93
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Aetna
Setting
Facility
Modifier
None
Typical Low
$44.67
Median
$56.23
Typical High
$263.03
Facility
None
$44.67
$56.23
$263.03
Aetna
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$56.23
Typical High
$79.43
Professional
None
$44.67
$56.23
$79.43
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$22.39
Median
$27.54
Typical High
$27.54
Professional
52 · Reduced service
$22.39
$27.54
$27.54
Cigna
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$85.11
Typical High
$114.82
Professional
None
$67.61
$85.11
$114.82
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$100.00
Typical High
$100.00
Professional
None
$81.28
$100.00
$100.00
Horizon BCBS
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$81.28
Typical High
$83.18
Professional
None
$79.43
$81.28
$83.18
United
Setting
Facility
Modifier
None
Typical Low
$91.20
Median
$91.20
Typical High
$100.00
Facility
None
$91.20
$91.20
$100.00
United
Setting
Professional
Modifier
None
Typical Low
$61.66
Median
$79.43
Typical High
$104.71
Professional
None
$61.66
$79.43
$104.71
1 more rate with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Ambetter
Setting
Professional
Modifier
GO · Occupational therapy plan
Typical Low
$104.71
Median
$104.71
Typical High
$104.71
Professional
GO · Occupational therapy plan
$104.71
$104.71
$104.71
Where New Jersey 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.