Submit cash-price facts for verification.

This provider-facing workflow collects structured public business, service, price, and contact facts. It never collects patient information and does not publish or verify a listing automatically.

Need to apply for a CashCare business presence first? Start with provider signup.

Unverified draft:This submission does not publish a listing, verify a provider, create authority, or enable payment. CashCare must independently verify organization control and every fact.

Provider and location

Organization NPI

Legal organization name

DBA / public name, optional

Location name

Street address

City

State

ZIP

Public business phone

Provider website

Authorized representative

Name

Role

Business email

Exact cash-price facts

Enter public business facts only. Do not include patient information, appointment details, insurance, payment data, or medical records.

Service 1

Category

Service name

CPT / HCPCS code, optional

Price type

Cash price, dollars

Included fee componentsUse Command-click to select multiple items.

Excluded fee componentsDo not select the same item as included and excluded.

Order / referral required

Price valid through

Provider booking/contact URL, optional if phone is supplied

Provider-owned public price URL, optional

Submission confirmationsI am authorized by this organization to submit these public business and price facts.The service and price facts are accurate and current through the dates shown.The public contact information is accurate.This submission contains no patient information, clinical narrative, appointment details, insurance information, payment information, or medical records.CashCare may display these facts publicly only after independent verification.I have read and agree to the CashCare Terms of use, including the provider-submission, verification-label, price, and correction conditions.