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Medical Procedure Good Faith Estimate

 Below you will find a link to our Online Cost Estimator, which is a secure online portal to enable you to review a good faith estimate of the costs associated with your child’s procedure or surgery.

Things you will need to have on have available to complete the cost estimate:

  • The name of the surgical procedure and the CPT code provided by your doctor.
  • If you have insurance, you will need:
    1. The name of your insurance provider
    2. Insured Name
    3. Insured Date of Birth
    4. Gender
    5. Insurance Company Policy Number
  • If you do not have insurance (paying cash) you will need:
    1. Name
    2. Date of Birth


The listings of service descriptions and associated standard charges in the cost estimate link are provided for the purpose of complying with Section 2718(e) of the Public Health Service Act, as enacted by the Affordable Care Act, requiring hospitals to make public a list of the hospital’s standard charges for items and services provided by the hospital. These listings represent gross charges for services and are not meant to reflect in any manner the patient responsibility or out-of-pocket cost that a given patient may be expected to pay.