Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
Idaho Pricing in Context
In Idaho, CPT code 97167 (Evaluation For Occupational Therapy, Typically 1 Hour) carries an average Medicare payment of $71.46 — 6% below the national benchmark of $75.91. 8 providers across the state submitted claims for this procedure in 2023, performing 32 total services. Individual payments in ID ranged from N/A at the low end to N/A at the high end, reflecting differences in provider setting (office vs. facility), modifiers, and the specific geographic locality code applied within the state.
The average billed charge in Idaho is $125.38, which is the figure uninsured patients would most likely encounter before any negotiation or charity discount. Medicare, by statute, only reimburses the allowed amount — the balance between billed and paid is written off under provider participation agreements. Insured patients generally pay a negotiated rate that falls between these two figures; the exact amount depends on plan design, deductible status, and in-network participation. Because Idaho sits below the national Medicare average, commercial rates in the state may also run lower than the US median.
Using RAND 2024 commercial-to-Medicare ratios for Medicine procedures, the estimated commercial insurance price in Idaho lands near $198.59, with self-pay cash prices typically around $105.40. Before scheduling, patients can request a Good Faith Estimate under the No Surprises Act, compare cash rates from hospital Machine-Readable Files, and confirm whether the provider is in-network with their specific plan. This page presents CMS reference data for informational use; it does not constitute medical or financial advice.
Frequently Asked Questions
How much does Evaluation For Occupational Therapy, Typically 1 Hour cost in Idaho?
The average Medicare payment for Evaluation For Occupational Therapy, Typically 1 Hour in Idaho is $71.46, which is 6% below the national average of $75.91. Providers in ID typically bill $125.38 for this procedure.
What does Evaluation For Occupational Therapy, Typically 1 Hour cost with insurance in Idaho?
With commercial insurance in Idaho, Evaluation For Occupational Therapy, Typically 1 Hour costs an estimated $198.59. Without insurance, the estimated cash price is $105.40. These estimates are based on RAND 2024 commercial-to-Medicare ratios and vary by insurer, plan, and facility.
How many providers perform Evaluation For Occupational Therapy, Typically 1 Hour in Idaho?
8 providers in Idaho billed Medicare for Evaluation For Occupational Therapy, Typically 1 Hour in 2023, performing 32 total services. Medicare payments ranged from N/A to N/A depending on the provider.
Is Evaluation For Occupational Therapy, Typically 1 Hour cheaper in Idaho than the national average?
Yes — Evaluation For Occupational Therapy, Typically 1 Hour costs 6% below the national average in Idaho. The state average Medicare payment is $71.46 compared to $75.91 nationally. Factors like local cost of living, provider competition, and regional Medicare fee schedules all influence state-level pricing.
Related Guides
Related Data Sources
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology — how this data is sourced, computed, and verified.