How much will your medical procedure cost?
Procedure: Medical procedure and the CPT code that your doctor gave you. 
Insurance Company: Who is your insurance provider? For example, Aetna, BCBS, Cigna, UHC-United Health Care, etc. Please contact Memorial MRI & Diagnostic at (713) 461-3399 if your insurance is not listed.
- Insured Name
- Insured Date Of Birth
- Gender – Male or Female
- Insurance Company Policy Number
Contact Information Email or Mobile: Provide your contact information to receive a copy of your estimate.
By submitting the cost estimator form – I have read and understood this disclaimer.
The estimates we provide are only related to your facility bill. Our fees do not include your surgeon, anesthesiologist, pathologist, and radiologist’s fees. Your personal physician or other physicians providing you with services related to your facility stay or visit will bill you separately. These providers may or may not participate in the same health plans as our facility. Please contact them directly to verify they participate in your health plan.
It is possible that your actual price and out-of-pocket costs could vary significantly from the estimate due to a variety of reasons including, but not limited to, medical complications, additional procedures that are not included in this estimate, hardware and implants your surgeon may use, or changes in your insurance benefits. Thank you for your understanding.
**Disclaimer: Memorial MRI & Diagnostic makes no guarantees regarding the accuracy of the pricing information provided herein. The pricing information provided by this website is strictly an estimate of prices, and Memorial MRI & Diagnostic cannot guarantee the accuracy of any estimates. All estimates are based on information provided by a prospective patient and do not include, among other things, any unforeseen complications, additional tests or procedures, and non-facility related charges, any of which may increase the ultimate cost of the services provided. Any prospective patient should understand that a final bill for services rendered at Memorial MRI & Diagnostic may differ substantially from the information provided by this website, and Memorial MRI & Diagnostic shall not be liable for any inaccuracies.