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Occupational Therapy Evaluation, Moderate Complexity

Virginia 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?

$81.28

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $79.43 from a physician practice, and about $95.50 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 8 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 $97.72
FacilityA hospital or hospital-owned outpatient department$95.50$75.86 to $132

How much rates vary

Facilitymedian $95 · 10th to 90th $60 to $224Professionalmedian $79 · 10th to 90th $58 to $123
$20.0$100.0$500.0$2.0K$10.0Kfacility $95professional $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
$60.26
Median
$95.50
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$72.44
Typical High
$100.00
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$87.10
Typical High
$123.03
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$97.72
Typical High
$199.53
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$120.23
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$85.11
Typical High
$154.88
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$107.15
Typical High
$125.89
Medcost
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
Medcost
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$83.18
Typical High
$131.83
Medcost
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Sentara
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$100.00
Typical High
$389.05
Sentara
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$100.00
Typical High
$389.05
United
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$109.65
Typical High
$114.82
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$87.10
Typical High
$114.82

Where Virginia 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.

Virginia $81.28 · 29th 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.