CPT 97166
The standard charge for Occupational Therapy Evaluation - Moderate Complexity is $253.86. However, the price you pay depends on the rate negotiated by your insurance plan and what portion your insurance plan requires you to contribute towards that amount. Enter your info below to start your estimate.
To calculate an estimate of your cost, you will need two things:
LOCATION
955 South Bailey Avenue, South Haven, MI, 49090CONTACT
(269) 637-5271 Visit WebsiteBronson South Haven Hospital is committed to empowering our patients to make informed decisions about their healthcare. This includes helping patients understand the cost of care and the availability of financial assistance.
In compliance with federal law, Bronson South Haven Hospital provides a list of standard charges. These are reviewed on an annual basis. Charges for hospital services are not equivalent to the actual amount paid by insurance companies or patients. The amount paid for services is based on many factors, including health insurance benefit plans, applicable discounts, and services provided based on each patient’s unique needs.
I understand that the list of standard charges includes only hospital services and does not contain professional fees for non-Bronson South Haven Hospital physicians or advanced practice providers. It does not contain professional fees for anesthesia, physicians or advanced practice providers.
I understand that a single line item charge may not represent a complete medical service. In general, multiple charge line items are necessary to represent all components of a service (e.g. procedures, supplies, and drugs).
I understand that the list of standard charges is not intended for media use.
I understand prices are the list price of all hospital charges and not necessarily what my insurance company will pay or what I will owe to the hospital. My actual bill may include one or more of list price charges.
The hospital typically accepts a rate that is less than the list charges. Your insurer will determine what you will owe after they have paid their agreed upon amount.
We know that the billing and payment processes may seem overwhelming at times. Please contact our team at 269-341-6166.
Choose a plan to view the insurance rate estimate.
Total estimated charges
$253.86Insurance Discount
-$25.39Price Negotiated by Insurer
$228.47Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$91.76HC ELVAREX ZIPPER
$62.35HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$90.00HC SQ OR IM INJECTION
$134.81HC TE MANUAL TX EACH 15 MIN
$103.00HC THERAPEUTIC ACTIVITIES EA 15 MIN
$88.96HC THERAPEUTIC EX EACH 15 MIN
$103.00This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$126.93Price Negotiated by Insurer
$126.93Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$50.98HC ELVAREX ZIPPER
$34.64HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$9.09HC SQ OR IM INJECTION
$69.73HC TE MANUAL TX EACH 15 MIN
$57.22HC THERAPEUTIC ACTIVITIES EA 15 MIN
$49.42HC THERAPEUTIC EX EACH 15 MIN
$57.22This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$7.62Price Negotiated by Insurer
$246.24Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$98.90HC ELVAREX ZIPPER
$67.20HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$97.00HC SQ OR IM INJECTION
$145.30HC TE MANUAL TX EACH 15 MIN
$111.01HC THERAPEUTIC ACTIVITIES EA 15 MIN
$95.87HC THERAPEUTIC EX EACH 15 MIN
$111.01This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$7.62Price Negotiated by Insurer
$246.24Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$98.90HC ELVAREX ZIPPER
$67.20HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$97.00HC SQ OR IM INJECTION
$145.30HC TE MANUAL TX EACH 15 MIN
$111.01HC THERAPEUTIC ACTIVITIES EA 15 MIN
$95.87HC THERAPEUTIC EX EACH 15 MIN
$111.01This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$152.32Price Negotiated by Insurer
$101.54Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$40.78HC ELVAREX ZIPPER
$27.71HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$5.12HC SQ OR IM INJECTION
$39.24HC TE MANUAL TX EACH 15 MIN
$45.78HC THERAPEUTIC ACTIVITIES EA 15 MIN
$39.54HC THERAPEUTIC EX EACH 15 MIN
$45.78This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$45.97Price Negotiated by Insurer
$207.89Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$83.50HC ELVAREX ZIPPER
$56.73HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$81.89HC SQ OR IM INJECTION
$122.66HC TE MANUAL TX EACH 15 MIN
$93.71HC THERAPEUTIC ACTIVITIES EA 15 MIN
$80.94HC THERAPEUTIC EX EACH 15 MIN
$93.71This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$57.04Price Negotiated by Insurer
$196.82Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$79.05HC ELVAREX ZIPPER
$53.71HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$77.53HC SQ OR IM INJECTION
$116.13HC TE MANUAL TX EACH 15 MIN
$88.73HC THERAPEUTIC ACTIVITIES EA 15 MIN
$76.63HC THERAPEUTIC EX EACH 15 MIN
$88.73This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$50.77Price Negotiated by Insurer
$203.09Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$81.57HC ELVAREX ZIPPER
$55.42HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$80.00HC SQ OR IM INJECTION
$119.83HC TE MANUAL TX EACH 15 MIN
$91.55HC THERAPEUTIC ACTIVITIES EA 15 MIN
$79.07HC THERAPEUTIC EX EACH 15 MIN
$91.55This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$15.23Price Negotiated by Insurer
$238.63Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$95.84HC ELVAREX ZIPPER
$65.12HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$94.00HC SQ OR IM INJECTION
$140.80HC TE MANUAL TX EACH 15 MIN
$107.57HC THERAPEUTIC ACTIVITIES EA 15 MIN
$92.91HC THERAPEUTIC EX EACH 15 MIN
$107.57This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$50.77Price Negotiated by Insurer
$203.09Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$81.57HC ELVAREX ZIPPER
$55.42HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$80.00HC SQ OR IM INJECTION
$119.83HC TE MANUAL TX EACH 15 MIN
$91.55HC THERAPEUTIC ACTIVITIES EA 15 MIN
$79.07HC THERAPEUTIC EX EACH 15 MIN
$91.55This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
$0.00Price Negotiated by Insurer
$253.86Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$101.96HC ELVAREX ZIPPER
$69.28HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$100.00HC SQ OR IM INJECTION
$149.79HC TE MANUAL TX EACH 15 MIN
$114.44HC THERAPEUTIC ACTIVITIES EA 15 MIN
$98.84HC THERAPEUTIC EX EACH 15 MIN
$114.44This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$7.62Price Negotiated by Insurer
$246.24Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$98.90HC ELVAREX ZIPPER
$67.20HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$97.00HC SQ OR IM INJECTION
$145.30HC TE MANUAL TX EACH 15 MIN
$111.01HC THERAPEUTIC ACTIVITIES EA 15 MIN
$95.87HC THERAPEUTIC EX EACH 15 MIN
$111.01This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$25.39Price Negotiated by Insurer
$228.47Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$91.76HC ELVAREX ZIPPER
$62.35HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$90.00HC SQ OR IM INJECTION
$134.81HC TE MANUAL TX EACH 15 MIN
$103.00HC THERAPEUTIC ACTIVITIES EA 15 MIN
$88.96HC THERAPEUTIC EX EACH 15 MIN
$103.00This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$38.08Price Negotiated by Insurer
$215.78Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$86.67HC ELVAREX ZIPPER
$58.89HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$85.00HC SQ OR IM INJECTION
$127.32HC TE MANUAL TX EACH 15 MIN
$97.27HC THERAPEUTIC ACTIVITIES EA 15 MIN
$84.01HC THERAPEUTIC EX EACH 15 MIN
$97.27This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$45.69Price Negotiated by Insurer
$208.17Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$83.61HC ELVAREX ZIPPER
$56.81HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$82.00HC SQ OR IM INJECTION
$122.83HC TE MANUAL TX EACH 15 MIN
$93.84HC THERAPEUTIC ACTIVITIES EA 15 MIN
$81.05HC THERAPEUTIC EX EACH 15 MIN
$93.84This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$88.85Price Negotiated by Insurer
$165.01Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$66.27HC ELVAREX ZIPPER
$45.03HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$65.00HC SQ OR IM INJECTION
$97.36HC TE MANUAL TX EACH 15 MIN
$74.39HC THERAPEUTIC ACTIVITIES EA 15 MIN
$64.25HC THERAPEUTIC EX EACH 15 MIN
$74.39This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$31.43Price Negotiated by Insurer
$222.43Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$69.18HC ELVAREX ZIPPER
$60.70HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$12.63HC SQ OR IM INJECTION
$58.20HC TE MANUAL TX EACH 15 MIN
$60.39HC THERAPEUTIC ACTIVITIES EA 15 MIN
$79.05HC THERAPEUTIC EX EACH 15 MIN
$73.57This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$75.90Price Negotiated by Insurer
$177.96Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$55.34HC ELVAREX ZIPPER
$48.57HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$10.10HC SQ OR IM INJECTION
$46.56HC TE MANUAL TX EACH 15 MIN
$48.31HC THERAPEUTIC ACTIVITIES EA 15 MIN
$63.24HC THERAPEUTIC EX EACH 15 MIN
$58.86This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.
Total estimated charges
$253.86Insurance Discount
-$30.46Price Negotiated by Insurer
$223.40Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
HC ADL TRAINING EA 15 MIN
$89.72HC ELVAREX ZIPPER
$60.97HC LEGAL BLOOD DRAW KZO CO/STATE/OTHER
$88.00HC SQ OR IM INJECTION
$131.82HC TE MANUAL TX EACH 15 MIN
$100.71HC THERAPEUTIC ACTIVITIES EA 15 MIN
$86.98HC THERAPEUTIC EX EACH 15 MIN
$100.71This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Bronson South Haven Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Bronson South Haven Hospital directly.