For Clinicians: Price Estimates Request Form

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Non-urgent requests can be expected to be returned in one business day.


The following disclaimer will apply to any estimates provided:

All price estimates are merely an estimation and should not be considered a price quote. Pricing is a good faith estimate based upon historic customary charges and is valid for 90 days from the date of this correspondence. Estimate includes hospital facility charges only. Professional fees for Surgeon, Anesthesiologist, Radiologist, Pathologist etc. are billed separately. Actual charges on the final hospital bill may vary based on medical condition, unknown circumstances or complications, final diagnosis, and recommended treatment ordered by the physician. If insurance coverage was provided to us to obtain a patient out of pocket estimate, the estimate is then based on benefits provided by the insurance company and any changes or inaccuracies could result in a difference in actual out of pocket amounts. It is recommended you contact the health insurance company to verify that the selected hospital is in-network for the services to be provided, as out of network benefits may result in higher out of pocket costs. If the balance owing creates a financial hardship for any reason, Providence does offer Financial Assistance! You can find the information online at and/or call our business office at 503-215-4300 (toll free 877-215-7833) to request more information about our Financial Assistance program to see if you may qualify.