CPT 97165
The standard charge for Occupational Therapy Evaluation - Low Complexity is $346.39. 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
44 South Main Street, Randolph, VT, 05060CONTACT
(802) 728-4441 Visit WebsiteGifford Medical Center 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, Gifford Medical Center 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-Gifford Medical Center 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 802-728-7000.
Choose a plan to view the insurance rate estimate.
Total estimated charges
$346.39Insurance Discount
-$17.32Price Negotiated by Insurer
$329.07Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$16,416.00PT EVAL LOW COMPLEX 20 MIN
$300.78THERAPEUTIC EXERCISES
$31.35TOTAL HIP ARTHROPLASTY
$3,238.55TOTAL KNEE ARTHROPLASTY
$3,434.25This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$36.06Price Negotiated by Insurer
$310.33Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$15,481.15KETOROLAC 15 MG/ML VIAL
$1.38PT EVAL LOW COMPLEX 20 MIN
$283.65THERAPEUTIC EXERCISES
$29.56TOTAL HIP ARTHROPLASTY
$3,054.12TOTAL KNEE ARTHROPLASTY
$3,238.68This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$192.97Price Negotiated by Insurer
$153.42Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$7,653.31PT EVAL LOW COMPLEX 20 MIN
$140.23THERAPEUTIC EXERCISES
$14.62TOTAL HIP ARTHROPLASTY
$1,509.85TOTAL KNEE ARTHROPLASTY
$1,601.08This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$36.06Price Negotiated by Insurer
$310.33Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$15,481.15KETOROLAC 15 MG/ML VIAL
$1.38PT EVAL LOW COMPLEX 20 MIN
$283.65THERAPEUTIC EXERCISES
$29.56TOTAL HIP ARTHROPLASTY
$3,054.12TOTAL KNEE ARTHROPLASTY
$3,238.68This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$137.86Price Negotiated by Insurer
$208.53Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$10,402.56PT EVAL LOW COMPLEX 20 MIN
$190.60THERAPEUTIC EXERCISES
$19.87TOTAL HIP ARTHROPLASTY
$2,052.22TOTAL KNEE ARTHROPLASTY
$2,176.23This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$51.96Price Negotiated by Insurer
$294.43Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$14,688.00PT EVAL LOW COMPLEX 20 MIN
$269.12THERAPEUTIC EXERCISES
$28.05TOTAL HIP ARTHROPLASTY
$2,897.65TOTAL KNEE ARTHROPLASTY
$3,072.75This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$65.81Price Negotiated by Insurer
$280.58Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$13,996.80PT EVAL LOW COMPLEX 20 MIN
$256.45THERAPEUTIC EXERCISES
$26.73TOTAL HIP ARTHROPLASTY
$2,761.29TOTAL KNEE ARTHROPLASTY
$2,928.15This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$190.51Price Negotiated by Insurer
$155.88Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$7,776.00PT EVAL LOW COMPLEX 20 MIN
$142.47THERAPEUTIC EXERCISES
$14.85TOTAL HIP ARTHROPLASTY
$1,534.05TOTAL KNEE ARTHROPLASTY
$1,626.75This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$71.01Price Negotiated by Insurer
$275.38Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$13,737.60PT EVAL LOW COMPLEX 20 MIN
$251.70THERAPEUTIC EXERCISES
$26.23TOTAL HIP ARTHROPLASTY
$2,710.16TOTAL KNEE ARTHROPLASTY
$2,873.93This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$173.19Price Negotiated by Insurer
$173.20Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$8,640.00PT EVAL LOW COMPLEX 20 MIN
$158.30THERAPEUTIC EXERCISES
$16.50TOTAL HIP ARTHROPLASTY
$1,704.50TOTAL KNEE ARTHROPLASTY
$1,807.50This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$69.28Price Negotiated by Insurer
$277.11Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$13,824.00PT EVAL LOW COMPLEX 20 MIN
$253.29THERAPEUTIC EXERCISES
$26.40TOTAL HIP ARTHROPLASTY
$2,727.20TOTAL KNEE ARTHROPLASTY
$2,892.00This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$69.28Price Negotiated by Insurer
$277.11Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$13,824.00PT EVAL LOW COMPLEX 20 MIN
$253.29THERAPEUTIC EXERCISES
$26.40TOTAL HIP ARTHROPLASTY
$2,727.20TOTAL KNEE ARTHROPLASTY
$2,892.00This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$69.28Price Negotiated by Insurer
$277.11Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$13,824.00PT EVAL LOW COMPLEX 20 MIN
$253.29THERAPEUTIC EXERCISES
$26.40TOTAL HIP ARTHROPLASTY
$2,727.20TOTAL KNEE ARTHROPLASTY
$2,892.00This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$190.51Price Negotiated by Insurer
$155.88Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$7,776.00PT EVAL LOW COMPLEX 20 MIN
$142.47THERAPEUTIC EXERCISES
$14.85TOTAL HIP ARTHROPLASTY
$1,534.05TOTAL KNEE ARTHROPLASTY
$1,626.75This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$24.25Price Negotiated by Insurer
$322.14Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$16,070.40PT EVAL LOW COMPLEX 20 MIN
$294.45THERAPEUTIC EXERCISES
$30.69TOTAL HIP ARTHROPLASTY
$3,170.37TOTAL KNEE ARTHROPLASTY
$3,361.95This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$152.41Price Negotiated by Insurer
$193.98Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$14,688.00PT EVAL LOW COMPLEX 20 MIN
$177.30THERAPEUTIC EXERCISES
$28.05TOTAL HIP ARTHROPLASTY
$2,897.65TOTAL KNEE ARTHROPLASTY
$3,072.75This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$190.51Price Negotiated by Insurer
$155.88Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$7,776.00PT EVAL LOW COMPLEX 20 MIN
$142.47THERAPEUTIC EXERCISES
$14.85TOTAL HIP ARTHROPLASTY
$1,534.05TOTAL KNEE ARTHROPLASTY
$1,626.75This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$17.32Price Negotiated by Insurer
$329.07Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$16,416.00PT EVAL LOW COMPLEX 20 MIN
$300.78THERAPEUTIC EXERCISES
$31.35TOTAL HIP ARTHROPLASTY
$3,238.55TOTAL KNEE ARTHROPLASTY
$3,434.25This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$190.51Price Negotiated by Insurer
$155.88Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$7,776.00PT EVAL LOW COMPLEX 20 MIN
$142.47THERAPEUTIC EXERCISES
$14.85TOTAL HIP ARTHROPLASTY
$1,534.05TOTAL KNEE ARTHROPLASTY
$1,626.75This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.
Total estimated charges
$346.39Insurance Discount
-$190.51Price Negotiated by Insurer
$155.88Deductible 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.
FEMORAL TROCHLEAR 7.0X5MM XL
$7,776.00PT EVAL LOW COMPLEX 20 MIN
$142.47THERAPEUTIC EXERCISES
$14.85TOTAL HIP ARTHROPLASTY
$1,534.05TOTAL KNEE ARTHROPLASTY
$1,626.75This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Gifford Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Gifford Medical Center directly at (802) 728-4441.