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Occupational Therapy Evaluation, Moderate Complexity

West 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?

$93.33

Typical negotiated rate. In West Virginia, July 2026.

Insurers have agreed to pay about $93.33 for this service. The price depends on where it is billed: about $93.33 from a physician practice, and about $93.33 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 5 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$93.33$72.44 to $126
FacilityA hospital or hospital-owned outpatient department$93.33$93.33 to $102

How much rates vary

Facilitymedian $93 · 10th to 90th $93 to $115Professionalmedian $93 · 10th to 90th $60 to $214
$50.0$100.0$200.0$500.0facility $93professional $93

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
$93.33
Median
$93.33
Typical High
$102.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$93.33
Typical High
$213.80
CareSource
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$104.71
Typical High
$125.89
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$100.00
Typical High
$154.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$165.96
Typical High
$165.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$114.82
Typical High
$489.78
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$102.33
Typical High
$158.49
United
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$147.91
United
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$87.10
Typical High
$131.83

Where West 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.

West Virginia $93.33 · 18th 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.