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Galactic Urology Center (GUC)

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:
52356 - Cystourethroscopy, with ureteral catheterization
50393 - Placement of indwelling ureteral stent (eg, Gibbons or double-J type)


Do urology practices need to provide good faith estimates?

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

Are urologists subject to GFE regulations?

All urology practices, including urologists and urology clinics, must comply with good faith estimate regulations.

What type of urology patients are required to receive good faith estimates?

Urology 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 



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Ensure No Surprises Act compliance for your urology practice without the added expenses or stress of hiring extra staff.

Urology practices, we've got you covered with our compliance solutions for the No Surprises Act's legal requirements on Good Faith Estimates. No need to hire additional GFE-dedicated staff for repetitive tasks, as our automated email/text estimates provide fully HIPAA-compliant encrypted letters with two-factor authentication. And for those who prefer paper estimates, we've got that option available as well.

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Streamline your urology practice's finances: automate benefit checks to reduce bad debt and administrative costs

Automated eligibility verification can help urology practices optimize their staff's efficiency, resulting in reduced administrative costs, smoother billing processes, accurate payer identification, and fewer back-end denials that create bad debt as patient volume increases.

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Boost your urology practice revenue by enhancing patient collections and receiving payments quicker, all while elevating patient experience

Help your urology practice's patients feel more confident about getting the care they need. Provide them with clear out-of-pocket cost projections upfront, which go beyond just co-pays. By allowing patients to make deposits online from our estimates, you'll save your front desk from an inefficient and uncomfortable step during their visit.


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

Get paid in full by bringing clarity to your revenue cycle