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Occupational Therapy Evaluation, Moderate Complexity

Utah 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 Utah, July 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $85.11 from a physician practice, and about $85.11 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 7 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$85.11$66.07 to $112
FacilityA hospital or hospital-owned outpatient department$85.11$85.11 to $126

How much rates vary

Facilitymedian $85 · 10th to 90th $85 to $145Professionalmedian $85 · 10th to 90th $56 to $316
$50$100$200$500facility $85professional $85

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
$85.11
Median
$85.11
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$85.11
Typical High
$331.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
Cigna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$93.33
Typical High
$190.55
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$229.09
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$144.54
Typical High
$181.97
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$107.15
Typical High
$120.23
Select Health
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$120.23
Select Health
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$104.71
Typical High
$117.49
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$138.04
Typical High
$218.78
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
United
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$91.20
Typical High
$102.33

Where Utah sits

The same service costs 2.8 times more in Alaska than in Delaware. 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.

Utah· 23rd of 51

$85.11

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.