go back

Occupational Therapy Evaluation, Moderate Complexity

New Mexico 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 New Mexico, July 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $79.43 from a physician practice, and about $148 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$79.43$63.10 to $112
FacilityA hospital or hospital-owned outpatient department$148$97.72 to $661

How much rates vary

Facilitymedian $148 · 10th to 90th $76 to $1,096Professionalmedian $79 · 10th to 90th $48 to $174
$100.0$1.0K$10.0K$100.0Kfacility $148professional $79

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
$114.82
Median
$147.91
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$77.62
Typical High
$302.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$724.44
Typical High
$1,258.93
BCBS
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$93.33
Typical High
$114.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$75.86
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$95.50
Typical High
$138.04
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$144.54
Providence
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$89.13
Typical High
$114.82
Providence
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$95.50
Typical High
$138.04
United
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$100.00
Typical High
$114.82
United
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$93.33
Typical High
$123.03

Where New Mexico 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 Mexico $85.11 · 21st 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.