Payment is due at the time of service.

The final fee for your endodontic treatment is based on the treatment provided, which may differ from the estimate.

We are always happy to provide an cost estimate based on the referral from your dentist. If you have dental insurance we will need that information to include it with the estimate. 

Payment Options:  If you have any questions regarding your appointment, fees or estimates please call to prior to your appointment. We will be happy to provided you with an estimated out of pocket cost.

We take most credit cards(Visa, MasterCard, Discover, American Express), checks, cash as well as CareCredit. 

Fee Estimates / Dental Insurance Information.

If you would like us to provide an estimate of your out-of-pocket costs we will need your insurance information - if you have a secondary insurance we will need that information as well:

Primary member - this is the person who is the main subscriber for the plan, generally through your employer. If your insurance is primary through your spouse / parent / partner we will need their complete information as well as Yours (Dependent) for all insurance plans

1. Name of Dental Insurance Company with phone number
2. Primary Complete Name (this is the person subscribed to the dental insurance plan first)
3. Primary Date of Birth  
4. Dental Insurance ID number (or SSN)
5. Patient  (Dependent) Name and Date of Birth
6. Primary Zip code

The general fee for the Exam and CBCT is $426 (without insurance) and includes most services necessary for the examination and diagnosis for treatment. This can include additional x-rays along with the CBCT that may incur an additional charge. We cannot accept CBCT from another office, even if you just had it done. The file cannot be transferred to us in whole for manipulation.

Endodontic fees usually range from $1,200 to $1,950 or more per tooth, depending on treatment required, in addition to the Exam fees. It is always a good idea to give us a call for information specific to your situation.

All treatment starts with a consultation which includes a CBCT, X-rays and Exam with the Doctor. We cannot provide treatment without a consultation and CBCT.

If you have Dental Insurance:

When possible we will verify your insurance and only charge the estimated patient portion at the time of service. Please keep in mind that there are no guarantees of insurance coverage as the information provided to us by your insurance company is limited. 

If your plan has a 'Fee Schedule' or 'Maximum Allowed' chances are they will not tell us what that is. We can submit for a pre-authorization but that can take 30+ days and is still not guaranteed (however it's usually a good indicator of what they will cover).

We are In-Network with Delta Dental!
We are Premier / PPO / EPO.

We are Out-of-Network for all other insurances.

We cannot bill OHP / Jackson Care / Medicare / Insurance that requires in-network participation.

Verify your out-of-network benefits! Depending on how your specific plan is set up the benefits may be the same for In and Out of network, or they can be very different!

For us to be able to bill your insurance plan you would need to have Out of Network benefits available (except for Delta Dental).  If your plan requires a participating provider we cannot bill your insurance. If you are unsure please contact your insurance company directly or call us and we can help. Most insurance companies have a website you can log into and search for in-network providers as well as review your plan documentation. That said, most endodontist specialists in southern Oregon are out-of-network.

You will need to provide your insurance information to us prior to your appointment / treatment. Please provide (in person, fax, email) a legible copy of your insurance card [front and back], Primary Member (you, spouse, parent, etc) Full Name, Date of Birth, Insurance ID number or SSN (if that is what your insurance uses) and the same information for the patient if they are secondary.

NOTE! If your insurance requires In-Network participation, but there are No In-Network providers within a reasonable range, you may be able to get an authorization from your insurance company to go to a provider Out of Network. You would need to call your insurance directly (we cannot do this for you).

The forms linked below are blank forms you can view, print and complete at home. This will require you to have a printer.

The PDF files will pop open in a new browser window, click the links to access.

Blank New Patient Forms: [ New Patient ]

Consent to release dental records form: [ Consent to Release ]