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Occupational Therapy Evaluation, Moderate Complexity

Ohio 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 Ohio, 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 $138 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 9 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$60.26 to $95.50
FacilityA hospital or hospital-owned outpatient department$138$100 to $219

How much rates vary

Facilitymedian $138 · 10th to 90th $63 to $269Professionalmedian $74 · 10th to 90th $55 to $132
$1.0$5.0$20.0$100.0$500.0facility $138professional $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
$60.26
Median
$128.82
Typical High
$269.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$69.18
Typical High
$109.65
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$87.10
Typical High
$147.91
Aultcare
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$134.90
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$77.62
CareSource
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$97.72
Typical High
$120.23
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$100.00
Typical High
$128.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$128.82
Typical High
$165.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$91.20
Typical High
$154.88
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$199.53
Typical High
$363.08
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$91.20
Typical High
$154.88
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$77.62
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$109.65
Typical High
$190.55
United
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$100.00
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$79.43
Typical High
$109.65

Where Ohio 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.

Ohio $75.86 · 36th 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.