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Thank you for your pre-registration estimate request

Please complete the secure form below for a Tufts Medical Center, Lowell General Hospital, or Melrose Wakefield estimate request, and a member of the Pre-Registration team will contact you with the applicable estimate. This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. See more information.

If you have insurance, we suggest that you contact your insurance company and confirm that the services required are "covered services" under your specific plan. If they are "not covered", then you would be considered "self-pay – or uninsured" for these services.

For faster service, please contact your physician's office to obtain the applicable procedural or CPT code(s), so we may provide you with our best estimate of your financial responsibility.

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Patient Details
Facility
Patient Name
Date of Birth
Primary Phone
Email Address
Existing Patient
MRN (if available)
Date of Service (if scheduled)
Insurance Company
Policy Number
Group Number
Provider
Service Type
Service Level
CPT Code(s)
DX Code(s) (Reason for Visit Codes)
Cosmetic Cases
J Codes
Contact Info
Name
Practice
Phone
Email
Date Estimate Requested
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Disclaimer:Tufts Medicine strives to provide you with the information you need to make an informed decision; however, please understand that this estimate is not a guarantee of final charges. You will be responsible for any additional costs/procedures that are not included in this estimate, which may vary based on your insurance contract and benefits, medical condition and any additional testing, procedures, or pharmaceuticals ordered by your physician.

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