Please note: If you have a personal medical question or a question about scheduling an appointment, please contact your personal care provider for information. For non-emergency information, call our Customer Service Team at 717-544-4953.

Request an Estimate Form

Typically, we cannot process a price estimate request without a 5-digit CPT code (also known as a procedure code).

If you do not have a CPT code, please contact the ordering physician’s office for assistance.

Your Information

First Name

Last Name

Phone Number

May we leave a message on your answering machine?

Information Request

5 Digit CPT Code

CPT Code not available

Description of the procedure being performed

Is this an inpatient or outpatient procedure?

Inpatient

Outpatient

Additional information that may help us with producing an estimate.

Enter Code Above

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Request an Estimate from the Billing Department

If you are experiencing a medical emergency, please dial 911 for immediate assistance.

Request an Estimate Form

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