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Request Price Estimate

Use this form to get an estimate on the costs of a planned medical procedure.

Diagnosis Related Group Estimate

The inpatient Diagnosis Related Group (DRG) Estimate (PDF) listing is the median historical case rates for the last year for the Medical Center only and does not include other expenses such as for the doctor, rehabilitation, home health or other pre- and post-operative care. They also assume services are provided without complications. The final bill you receive will include charges for actual services provided to you. You will be responsible for any additional charges.

Get An Estimate

Complete this form to receive a price estimate for services at UVA Medical Center. The estimate will include both doctor and hospital expenses. It will not include charges for rehabilitation, home health or other pre- and post-operative care. It also assumes services are provided without complications.

If you have questions about how to complete the form, please contact your doctor’s office for help. To ensure an accurate estimate, please provide as much detail as possible.

The final bill you receive will include charges for actual services provided to you. These charges may differ from the estimate. You will be responsible for any additional charges in excess of the estimate.

Most estimates take two business days to complete. Complex cases may take longer. This estimate will not provide an insurance benefit review. Please contact your insurer directly for more information about your financial obligation.

Requestor Information

Patient Information (if other than requestor)
Description of Services for Charge Estimate

Questions about the price estimate process? Call 434.243.7283 or email us.

Make an Appointment

Call us at 434.243.3675

or make an appointment online.