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Occupational Therapy Evaluation, Moderate Complexity

South Dakota 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?

$97.72

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $97.72 for this service. The price depends on where it is billed: about $97.72 from a physician practice, and about $123 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$97.72$74.13 to $129
FacilityA hospital or hospital-owned outpatient department$123$97.72 to $251

How much rates vary

Facilitymedian $123 · 10th to 90th $79 to $302Professionalmedian $98 · 10th to 90th $72 to $186
$100.0$200.0$500.0facility $123professional $98

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
$120.23
Median
$302.00
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$72.44
Typical High
$97.72
Avera
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$125.89
Typical High
$134.90
Avera
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$125.89
Typical High
$138.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$109.65
Typical High
$112.20
Medica
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$107.15
Typical High
$251.19
Medica
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$91.20
Typical High
$363.08
Midlands
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$128.82
Typical High
$151.36
Midlands
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$173.78
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$147.91
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$91.20
Typical High
$229.09
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$134.90
Typical High
$158.49

Where South Dakota 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 Dakota $97.72 · 14th 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.