Good Faith Estimates

Get Estimates for Our Services

If you would like to speak with an eligibility specialist regarding payment options, please call our office at: 410-837-2050 to make an appointment.

Si desea reunirse con un especialista en elegibilidad para evaluar las opciones de pago disponibles, llámenos al 410-837-2050 para programar una cita.

How much you will pay for your services at Chase Brexton Health Care will depend on your

  • insurance coverage,
  • family income,
  • the number of family members,
  • and how many visits are required to complete your care. 

If you are a self-pay patient, a Good Faith Estimate can help you determine which Sliding Fee Scale (SFS) you belong to and what you can expect your costs to be. Actual service costs could vary depending on the diagnosis codes for your visit. Our staff can help you determine your costs during your appointment.

Find Chase Brexton estimates for what to expect to be charged under your SFS for each service.  

Sliding Fee Scale - A  English/Spanish

Sliding Fee Scale - B English/Spanish 

Sliding Fee Scale - C English/Spanish

Sliding Fee Scale - D English/Spanish

Sliding Fee Scale - E English/Spanish

Sliding Fee Scale - F (Ryan White Only) English/Spanish

Self-Pay English/Spanish

Dental English/Spanish

Dental - Subsequent English/Spanish

Diabetic Eye Exam English/Spanish

Long Acting Reversible Contraception (LARC) & IUD English/Spanish

Nutrition Services English/Spanish

OB-GYN/MFM English/Spanish

Ryan White English/Spanish


This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created.

The Good Faith Estimate does not include any unknown or unexpected costs may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.

If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill.

You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate.

You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health of Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to or call 877-696- 6775. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit or call 877-696-6775.

Information on pricing information from partnering organizations can be found below:

Ascension (St. Agnes):

Johns Hopkins Health:

Mercy Hospital:

University of Maryland Health System:

Luminis Health: