First, tell us which service this estimate is being generated for and whether or not the patient has health insurance.
Designates a required field
CT Scan - Radiology
ER (please call for additional info)
Injections - Radiology
Mammogram - Radiology
MRI - Radiology
OB Gyn - Womens and Childrens, Family Practice
Ortho Department - Physician Charges
Other Professional Charges (please call for info)
Provider Office Visits and Urgent Care
Rehab Services (PT, OT and Speech Therapy)
Same Day Surgery Procedures
Shoppable Services not performed at DCMC
Specialty Services - Treatment Room
Ultrasound - Radiology
X-Ray - Radiology
Please select a category.
Please choose a service category
Please select a service.
Estimated Date of Service
Please select a date of today or later.
I have insurance and I know my information
I don't have insurance
Government (Medicare and Medicaid only)
Commercial (Excludes Medicare and Medicaid)