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Occupational Therapy Evaluation, High Complexity

South Dakota rates for HCPCS 97167

This is a thorough evaluation performed by an occupational therapist to assess a patient's ability to perform daily activities, such as dressing, cooking, or work tasks, when the patient's condition involves multiple complicating factors. It typically includes a detailed history, standardized assessments, and clinical judgment to develop a treatment plan for a patient with a more complex presentation than a routine evaluation. This level reflects more time and clinical complexity than a basic evaluation.

Rates data updated July 2026.

How much does Occupational Therapy Evaluation, High Complexity cost?

$97.72

Typical physician fee. In South Dakota, July 2026.

Insurers have agreed to pay about $97.72 for this service. Most negotiated rates run $74.13 to $129.

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.

How much rates vary

Professionalmedian $98 · 10th to 90th $71 to $186
$100$200professional $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
Professional
Modifier
Global
Typical Low
$63.10
Median
$72.44
Typical High
$97.72
Cigna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$109.65
Typical High
$112.20
Medica
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$91.20
Typical High
$331.13
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
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 Kentucky. 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.

South Dakota· 12th of 51

$97.72

AK $186KY $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.