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Tips for Completing Your Price Estimator

Service Category:

This field identifies the general category of services that you can choose from. Service Type: This field will vary by your chosen Service Category. It helps you to choose the particular service that you are planning to have.

Body Region:

This field identifies the area of the body that you are planning to have treated.


This procedure allows you to identify the specific service or procedure that you are planning to have.

Patient First and Last Name:

Please enter the name of the patient as it appears on the insurance card.

Phone Number:

What is the best phone number to reach you?

Date of Birth:

Patient birthdate is needed to access insurance benefit information.


Please identify if the patient is a male or a female.

Insurance Provider:

Please enter the insurance company name as it appears on the patient’s insurance card (for example Aetna PPO).

Insurance Plan:

Please enter the name of the specific insurance plan for the patient. An example of an Insurance Provider/Insurance Plan would be Aetna HMO.

Subscriber ID:

Please enter the member ID/Policy # or subscriber ID# as it appears on the patient's insurance card. This can be a combination of numbers and/or letters.

Relationship to Patient:

Please enter whether the estimate is for the (Subscriber/Self), a Dependent Spouse, a Dependent Child, or some Other Dependent.

Procedure Code:

Will be displayed in the estimate as a five digit CPT code or three digit DRG code assigned to the procedure or test.

Preferred Facility Type:

Will be displayed in the estimate as the Facility Type as either inpatient or outpatient. This is where the procedure will be performed.

IP versus OP Designation:

IP stands for Inpatient meaning the procedure would be done within the hospital with the intent to keep the patient overnight. OP stands for Outpatient meaning that the patient would be treated at the main hospital campus or any of our other outpatient campuses, and they would go home that same day.