Patient Cost Estimate

Financial Support

The information requested below is essential for providing you with the best estimate for your expected hospital services. If insurance information is provided, we will try to determine co-pay and/or deductible amounts for the most accurate estimated patient responsibility. If insurance information is not listed, an estimate will be given based on full patient responsibility. Please note: you will need estimates for both your physician and the facility in the event of a surgery.

Submit information by clicking on the "Submit Information" button located at the bottom of this page. Thank you for considering Baptist Health for your healthcare needs.

Florida Health Price Finder

The Agency for Health Care Administration places an emphasis on health care transparency for Florida's consumers. We have provided a link to the Florida Health Price Finder website to help you make more informed health care decisions.

Requestor's Information

(required)( * Indicates the information is required.)

First Name (required)^*

Last Name (required)^*

Street Address (required)^*

Apt/Suite

City (required)^*

State (required)^*

Zip (required)^*

Phone Number (required)^*

Phone Type (required)^*

Email Address (required)^*

Preferred Time to Contact (required)^*

Patient Information

First Name (required)^*

Middle

Last Name (required)^*

DOB (required)^*

Gender (required)^*

Description of Planned Service

Test/Procedure Name (required)^*

Diagnosis (required)^*

Type of Service (required)^*

Physician's Name (required)^*

Physician's Phone (required)^*

Is there insurance coverage for this service?

Yes No

Questions?

If you want to talk to someone or have any questions, we’re happy to help.

Patient Cost Estimate