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Occupational Therapy Evaluation, Moderate Complexity

South 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?

$74.13

Typical negotiated rate. In South Carolina, July 2026.

Insurers have agreed to pay about $74.13 for this service. The price depends on where it is billed: about $72.44 from a physician practice, and about $97.72 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$72.44$64.57 to $85.11
FacilityA hospital or hospital-owned outpatient department$97.72$70.79 to $195

How much rates vary

Facilitymedian $98 · 10th to 90th $69 to $316Professionalmedian $72 · 10th to 90th $58 to $100
$20.0$50.0$100.0$200.0$500.0facility $98professional $72

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
$70.79
Median
$97.72
Typical High
$257.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$70.79
Typical High
$100.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$213.80
Typical High
$512.86
BCBS
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$67.61
Typical High
$114.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$120.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$74.13
Typical High
$107.15
Medcost
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$85.11
Typical High
$138.04
Medcost
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$100.00
Typical High
$109.65
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$79.43
Typical High
$97.72

Where South 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.

South Carolina $74.13 · 44th 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.