CPT 97166
The standard charge for Occupational Therapy Evaluation - Moderate Complexity is $258.94. 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
$258.94Insurance Discount
-$25.89Price Negotiated by Insurer
$233.05Deductible 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
$93.60HC DRAW VENIPUNCTURE
$14.33HC JOBST FOAM PADDING
$10.20HC SQ OR IM INJECTION
$137.51HC TE MANUAL TX EACH 15 MIN
$105.06HC THERAPEUTIC ACTIVITIES EA 15 MIN
$90.74HC THERAPEUTIC EX EACH 15 MIN
$105.06This 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
$258.94Insurance Discount
-$163.13Price Negotiated by Insurer
$95.81Deductible 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
$38.48HC DRAW VENIPUNCTURE
$9.34HC JOBST FOAM PADDING
$4.19HC SQ OR IM INJECTION
$71.74HC TE MANUAL TX EACH 15 MIN
$43.19HC THERAPEUTIC ACTIVITIES EA 15 MIN
$37.30HC THERAPEUTIC EX EACH 15 MIN
$43.19This 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
$258.94Insurance Discount
-$7.77Price Negotiated by Insurer
$251.17Deductible 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
$100.88HC DRAW VENIPUNCTURE
$15.44HC JOBST FOAM PADDING
$10.99HC SQ OR IM INJECTION
$148.21HC TE MANUAL TX EACH 15 MIN
$113.23HC THERAPEUTIC ACTIVITIES EA 15 MIN
$97.80HC THERAPEUTIC EX EACH 15 MIN
$113.23This 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
$258.94Insurance Discount
-$155.36Price Negotiated by Insurer
$103.58Deductible 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
$41.60HC DRAW VENIPUNCTURE
$5.13HC JOBST FOAM PADDING
$4.53HC SQ OR IM INJECTION
$39.40HC TE MANUAL TX EACH 15 MIN
$46.69HC THERAPEUTIC ACTIVITIES EA 15 MIN
$40.33HC THERAPEUTIC EX EACH 15 MIN
$46.69This 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
$258.94Insurance Discount
-$45.44Price Negotiated by Insurer
$213.50Deductible 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
$85.75HC DRAW VENIPUNCTURE
$13.13HC JOBST FOAM PADDING
$9.34HC SQ OR IM INJECTION
$125.98HC TE MANUAL TX EACH 15 MIN
$96.24HC THERAPEUTIC ACTIVITIES EA 15 MIN
$83.13HC THERAPEUTIC EX EACH 15 MIN
$96.24This 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
$258.94Insurance Discount
-$45.44Price Negotiated by Insurer
$213.50Deductible 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
$85.75HC DRAW VENIPUNCTURE
$13.13HC JOBST FOAM PADDING
$9.34HC SQ OR IM INJECTION
$125.98HC TE MANUAL TX EACH 15 MIN
$96.24HC THERAPEUTIC ACTIVITIES EA 15 MIN
$83.13HC THERAPEUTIC EX EACH 15 MIN
$96.24This 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
$258.94Insurance Discount
-$51.79Price Negotiated by Insurer
$207.15Deductible 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
$83.20HC DRAW VENIPUNCTURE
$12.74HC JOBST FOAM PADDING
$9.06HC SQ OR IM INJECTION
$122.23HC TE MANUAL TX EACH 15 MIN
$93.38HC THERAPEUTIC ACTIVITIES EA 15 MIN
$80.66HC THERAPEUTIC EX EACH 15 MIN
$93.38This 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
$258.94Insurance Discount
-$15.54Price Negotiated by Insurer
$243.40Deductible 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
$97.76HC DRAW VENIPUNCTURE
$14.96HC JOBST FOAM PADDING
$10.65HC SQ OR IM INJECTION
$143.62HC TE MANUAL TX EACH 15 MIN
$109.73HC THERAPEUTIC ACTIVITIES EA 15 MIN
$94.77HC THERAPEUTIC EX EACH 15 MIN
$109.73This 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
$258.94Insurance Discount
-$51.79Price Negotiated by Insurer
$207.15Deductible 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
$83.20HC DRAW VENIPUNCTURE
$12.74HC JOBST FOAM PADDING
$9.06HC SQ OR IM INJECTION
$122.23HC TE MANUAL TX EACH 15 MIN
$93.38HC THERAPEUTIC ACTIVITIES EA 15 MIN
$80.66HC THERAPEUTIC EX EACH 15 MIN
$93.38This 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
$258.94Insurance Discount
-$7.77Price Negotiated by Insurer
$251.17Deductible 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
$100.88HC DRAW VENIPUNCTURE
$15.44HC JOBST FOAM PADDING
$10.99HC SQ OR IM INJECTION
$148.21HC TE MANUAL TX EACH 15 MIN
$113.23HC THERAPEUTIC ACTIVITIES EA 15 MIN
$97.80HC THERAPEUTIC EX EACH 15 MIN
$113.23This 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
$258.94Insurance Discount
$0.00Price Negotiated by Insurer
$258.94Deductible 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
$104.00HC DRAW VENIPUNCTURE
$15.92HC JOBST FOAM PADDING
$11.33HC SQ OR IM INJECTION
$152.79HC TE MANUAL TX EACH 15 MIN
$116.73HC THERAPEUTIC ACTIVITIES EA 15 MIN
$100.82HC THERAPEUTIC EX EACH 15 MIN
$116.73This 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
$258.94Insurance Discount
-$25.89Price Negotiated by Insurer
$233.05Deductible 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
$93.60HC DRAW VENIPUNCTURE
$14.33HC JOBST FOAM PADDING
$10.20HC SQ OR IM INJECTION
$137.51HC TE MANUAL TX EACH 15 MIN
$105.06HC THERAPEUTIC ACTIVITIES EA 15 MIN
$90.74HC THERAPEUTIC EX EACH 15 MIN
$105.06This 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
$258.94Insurance Discount
-$51.79Price Negotiated by Insurer
$207.15Deductible 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
$83.20HC DRAW VENIPUNCTURE
$10.74HC JOBST FOAM PADDING
$9.06HC SQ OR IM INJECTION
$82.50HC TE MANUAL TX EACH 15 MIN
$93.38HC THERAPEUTIC ACTIVITIES EA 15 MIN
$80.66HC THERAPEUTIC EX EACH 15 MIN
$93.38This 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
$258.94Insurance Discount
-$38.84Price Negotiated by Insurer
$220.10Deductible 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
$88.40HC DRAW VENIPUNCTURE
$13.53HC JOBST FOAM PADDING
$9.63HC SQ OR IM INJECTION
$129.87HC TE MANUAL TX EACH 15 MIN
$99.22HC THERAPEUTIC ACTIVITIES EA 15 MIN
$85.70HC THERAPEUTIC EX EACH 15 MIN
$99.22This 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
$258.94Insurance Discount
-$46.61Price Negotiated by Insurer
$212.33Deductible 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
$85.28HC DRAW VENIPUNCTURE
$13.05HC JOBST FOAM PADDING
$9.29HC SQ OR IM INJECTION
$125.29HC TE MANUAL TX EACH 15 MIN
$95.72HC THERAPEUTIC ACTIVITIES EA 15 MIN
$82.67HC THERAPEUTIC EX EACH 15 MIN
$95.72This 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
$258.94Insurance Discount
-$64.73Price Negotiated by Insurer
$194.21Deductible 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
$78.00HC DRAW VENIPUNCTURE
$11.94HC JOBST FOAM PADDING
$8.50HC SQ OR IM INJECTION
$114.59HC TE MANUAL TX EACH 15 MIN
$87.55HC THERAPEUTIC ACTIVITIES EA 15 MIN
$75.61HC THERAPEUTIC EX EACH 15 MIN
$87.55This 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
$258.94Insurance Discount
-$32.06Price Negotiated by Insurer
$226.88Deductible 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
$76.27HC DRAW VENIPUNCTURE
$13.92HC JOBST FOAM PADDING
$9.93HC SQ OR IM INJECTION
$64.17HC TE MANUAL TX EACH 15 MIN
$66.58HC THERAPEUTIC ACTIVITIES EA 15 MIN
$87.15HC THERAPEUTIC EX EACH 15 MIN
$81.11This 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
$258.94Insurance Discount
-$77.42Price Negotiated by Insurer
$181.52Deductible 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
$61.02HC DRAW VENIPUNCTURE
$11.14HC JOBST FOAM PADDING
$7.94HC SQ OR IM INJECTION
$51.33HC TE MANUAL TX EACH 15 MIN
$53.26HC THERAPEUTIC ACTIVITIES EA 15 MIN
$69.72HC THERAPEUTIC EX EACH 15 MIN
$64.89This 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
$258.94Insurance Discount
-$31.07Price Negotiated by Insurer
$227.87Deductible 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
$91.52HC DRAW VENIPUNCTURE
$14.01HC JOBST FOAM PADDING
$9.97HC SQ OR IM INJECTION
$134.46HC TE MANUAL TX EACH 15 MIN
$102.72HC THERAPEUTIC ACTIVITIES EA 15 MIN
$88.72HC THERAPEUTIC EX EACH 15 MIN
$102.72This 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.