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Jedi Pain Relief Clinic

Good Faith Estimate for Health Care Items and Services

Patient Identification Number: 156749125
Evergreen Ave
Mountain City, CO 34510
The following is a detailed list of expected chargers for the appointment scheduled for 11/2/2023. The estimated costs are valid for 12 months from the date of the Good Faith Estimate.
Details for Services and Items for appointment located at Mountain City:
99213 - Office or other outpatient visit
96372 - Injection administration, IM or SC, each additional injection


Do pain management practices need to provide good faith estimates?

Pain management practices are required to provide good faith estimates to patients who need them.

Are pain management practices subject to GFE regulations?

All pain management practices, including those specializing in chronic pain and acute pain, must comply with good faith estimate regulations.

What type of patients in pain management practices should be provided with good faith estimates?

Pain management practices must provide uninsured and self-paying patients with good faith estimates as required by the No Surprises Act.

Achieve compliance and boost collections at the same time

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Automatically send Good Faith Estimates via email, text, or letters

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Project out-of-pocket costs

Generate accurate estimates for patients that include deductibles, copays, and coinsurance.

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Unlock upfront payments

Enable patients to make upfront deposits and payment plan elections online, directly from their estimates.

3 wins for your 

Pain Management


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Ensure No Surprises Act compliance without the added expense of hiring more staff or the added stress for pain management practices.

Get relief from the burden of No Surprises Act's legal requirements on Good Faith Estimates by utilizing our services tailored to pain management practices. Say goodbye to the hassle and cost of hiring full-time GFE-dedicated staff. Our automated email and text estimates provide patients with fully HIPAA-compliant encrypted letters with two-factor authentication. We also offer paper estimates for those who prefer it.

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Streamline your pain management practice's financial operations with automated benefits checks to reduce bad debt and administrative costs.

By utilizing automated eligibility verification, pain management practices can increase efficiency among their existing staff, reduce administrative costs as patient volume increases, accurately bill the correct payer, have prior-authorization knowledge, and prevent back-end denials that result in bad debt.

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Enhance patient collections and expedite payments, all while elevating patient experience in your pain management practice

Empower your pain management patients to confidently seek care and make upfront deposits with transparent out-of-pocket projections provided before their appointment. Our online estimates allow patients to make deposits directly, saving your front desk time and avoiding any potential awkwardness during the appointment.


MD Clarity works with the tools you use to run your practice.

Improve your financial performance while providing a more transparent patient experience