Price Checker / CPT 97166
How much does Ot Evaluation Mod Complex 45 Min cost?
CPT 97166 · Based on 2026 Medicare rates and hospital-published pricing
The average hospital charge is about 2.1x the fair price. You have grounds to ask for a reduction.
Fair price
$390–$460
What this should cost
With insurance
~$520
Typical out-of-pocket
Overcharged if over
$580
Push back above this
The average hospital charge of $923 is $493 over the fair price (about 2.1x the fair rate).
What hospitals charge for Ot Evaluation Mod Complex 45 Min
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Rehabilitation Hospital of Rhode Island , RI | $6,123 | $6,123 | 5990% |
| UM Shore Medical Center at Cambridge , MD | $1,826 | — | 1716% |
| UM Upper Chesapeake Behavior Health Pavilion at Aberdeen , MD | $1,816 | — | 1706% |
| HealthSource Saginaw SAGINAW, MI | — | — | 1690% |
| UM Capital Region Medical Center Largo, MD | $1,530 | — | 1421% |
| UM Rehabilitation & Orthopaedic Institute Baltimore, MD | $1,220 | — | 1114% |
| UM Upper Chesapeake Medical Center Bel Air, MD | $1,113 | — | 1007% |
| UM Shore Medical Center at Chestertown Chestertown, MD | $1,103 | — | 997% |
| UM Charles Regional Medical Center La Plata, MD | $1,031 | — | 926% |
| UM Upper Chesapeake Medical Center Aberdeen Aberdeen, MD | $973 | — | 868% |
| Penn State Health Rehabilitation Hospital , PA | $330 | — | 860% |
| Mt. Washington Pediatric Hospital Baltimore, MD | $830 | — | 726% |
| MEDICAL CITY MENTAL HEALTH AND WELLNESS CENTER - ALLIANCE FORT WORTH, TX | $825 | — | 720% |
| Pennsylvania Psychiatric Institute Harrisburg, PA | $604 | — | 381% |
| Baptist Health Rehabilitation Institute-Little Rock , AR | $353 | $88 | 251% |
Were you billed for this procedure?
Send us your bill and we'll compare every line item against Medicare rates and your hospital's published prices. Free review, no obligation.
About Ot Evaluation Mod Complex 45 Min
CPT code 97166 refers to ot evaluation mod complex 45 min (billing description: "Ot eval mod complex 45 min"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $101 in a facility (hospital or surgery center) and $101 in a doctor's office.
The Medicare rate is the closest thing to an objective "what this work is actually worth." A fair cash price for the uninsured is generally 1.5–3x that rate. Hospital sticker (gross) charges are often far higher — but almost nobody actually pays them.
What to do if you were overcharged
- 1Send us your bill — we'll identify this code and compare it against the rates shown above.
- 2Get a dispute letter — citing the Medicare rate and your hospital's own published pricing data.
- 3We negotiate for you — 25% of savings, no savings = no fee.