Customized Price Quote

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Concord Imaging Center is pleased to offer you a customized estimate of your diagnostic imaging procedure.

Please fill in the required fields below and one of our certified medical coders will contact you via secure email with a price estimate within 24-48 business hours. In order to access the email you will need to create a passphrase that will be used to read all future messages from Hushmail (secure email platform), so be sure to remember it and keep it in a safe place.

First name

Last name

Email address

Phone number

Date of Birth

Insurance Carrier

Insurance Policy Number

Diagnostic Imaging Exam Type - Provide the diagnostic imaging exam type for the price inquiry (e.g. MRI-brain; Ultrasound-pelvic; X-ray-shoulder, etc.). If you know that your exam will be done with contrast, please indicate that.

CPT Code- this code can be obtained from your ordering provider.

Disclaimer:

The estimated cost is based on the information provided. If you have met all or part of your deductible or maximum out-of-pocket expenses, the actual amount you owe may be less.

I HAVE READ THE DISCLAIMER AND UNDERSTAND THIS IS AN ESTIMATE ONLY. MY ACTUAL BALANCE MAY BE DIFFERENT.

Your information will be encrypted.