Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
South Dakota Pricing in Context
In South Dakota, CPT code 97167 (Evaluation For Occupational Therapy, Typically 1 Hour) carries an average Medicare payment of $72.58 — 4% below the national benchmark of $75.91. 13 providers across the state submitted claims for this procedure in 2023, performing 66 total services. Individual payments in SD 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 South Dakota is $246.00, 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 South Dakota 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 South Dakota lands near $194.99, with self-pay cash prices typically around $138.99. 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 South Dakota?
The average Medicare payment for Evaluation For Occupational Therapy, Typically 1 Hour in South Dakota is $72.58, which is 4% below the national average of $75.91. Providers in SD typically bill $246.00 for this procedure.
What does Evaluation For Occupational Therapy, Typically 1 Hour cost with insurance in South Dakota?
With commercial insurance in South Dakota, Evaluation For Occupational Therapy, Typically 1 Hour costs an estimated $194.99. Without insurance, the estimated cash price is $138.99. 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 South Dakota?
13 providers in South Dakota billed Medicare for Evaluation For Occupational Therapy, Typically 1 Hour in 2023, performing 66 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 South Dakota than the national average?
Yes — Evaluation For Occupational Therapy, Typically 1 Hour costs 4% below the national average in South Dakota. The state average Medicare payment is $72.58 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.