Good Faith Estimate
Good Faith Estimate
A Good Faith Estimate is a projection of the typical charges for services provided at Family Health Services for those that are uninsured or underinsured and don’t qualify for our Sliding Fee Scale Discounts. The listed amounts are only an estimate; they are not an offer or contract for services. Final costs may vary from the estimates provided
| Procedure | Estimated Cost |
|---|---|
| Medical Visit | $33.00 – $446.00 |
| Dietitian | $5.00 – $40.00 |
| Behavioral Health | $113.00 – $225.00 |
| Dental Exam | $50.00 – $83.00 |
| Dental Cleaning | $63.00 – $90.00 |
| Dental Filling – per tooth | $125.00 – $318.00 |
| Dental Extraction – per tooth | $134.00 – $268.00 |
| Vision Eye Exam | $125.00 – $148.00 |
| Vision Refraction | $35.00 |
| Contact Fitting | $70.00 |
Disclaimer
This Good Faith Estimate shows a cost range for visits with Medical, Dental, or Behavioral Health providers. This Good Faith Estimate does not include any unknown or unexpected costs that may arise during your visit or any laboratory services or additional procedures that are rendered during your visit such as dental x-rays. The charge amounts will be reduced for those patients who qualify for our Sliding Fee Scale discounts.
To request or dispute a Good Faith Estimate please send an email to billing@familyhealthservices.org. You can also speak with any front desk receptionist to request a Good Faith Estimate.
