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Occupational Therapy Evaluation, Moderate Complexity

New Jersey 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?

$72.44

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $72.44 for this service. The price depends on where it is billed: about $70.79 from a physician practice, and about $186 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 5 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$70.79$64.57 to $87.10
FacilityA hospital or hospital-owned outpatient department$186$77.62 to $324

How much rates vary

Facilitymedian $186 · 10th to 90th $54 to $575Professionalmedian $71 · 10th to 90th $54 to $115
$50.0$100.0$200.0$500.0$1.0Kfacility $186professional $71

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
$53.70
Median
$190.55
Typical High
$575.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$69.18
Typical High
$112.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$87.10
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$117.49
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$79.43
Typical High
$117.49
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$91.20
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$79.43
Typical High
$117.49

Where New Jersey 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.

New Jersey $72.44 · 45th 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.