If you would like to get a price estimate for a medical procedure, complete the form here -- either electronically, or print out the form, complete it, and send it to us.

You must provide the information that is designated as “required” on the Patient Price Estimate Request Form for us to prepare an estimate. We will send a letter in response to this request within two business days of when we receive your request. The estimate that we provide will be a range of possible prices or an average price, depending upon your situation, for the facility only. The estimate will not include physician or other professional provider fees that are billed separately. The estimate will be based on the information you provide, may not be specific to any one BJC provider, and will not be specific to any particular insurance plan (if applicable).

If you have insurance, contact your health plan to make sure the BJC hospital you would like to use is a provider in your plan’s network. You also can get information related to your specific benefit plan (such as whether the service you desire is a covered benefit and the amount of deductible, co-payment or coinsurance you may owe).

The actual price of the service may be more or less than the estimate we provide. The actual price also may vary depending upon if you have chronic health issues, the medications you take, unexpected complications and other factors that may arise. The estimate is not a guarantee of what you may eventually owe.

BJC provides price information only on more common procedures, so an estimate may not be available for the procedure you are requesting. If an estimate is unavailable for the particular procedure you desire, someone will call you within one business day of receipt of your request to let you know that an estimate is not available.

Go to the electronic form.

Print out the form.