The estimate cannot be relied on as the final, set cost for services you may receive as actual expenses can and will vary from patient to patient depending upon your physician’s treatment choices and your particular health care needs.

The estimated patient cost is based on the information entered. If you have requested an estimate for a surgical procedure, this estimate does not include:
  • Pre-Procedure Office Visits
  • Post-Procedure Office Visits
  • Diagnostic Testing
  • Physician Services
If you have met all or part of your deductible or maximum out-of-pocket expenses, the actual amount you owe may be different. Note: The estimated cost is not a guarantee of insurance coverage. Please check with your insurance company if you need help understanding your benefits for the service chosen.

I HAVE READ AND UNDERSTAND THE ABOVE LIMITATIONS AND I FULLY UNDERSTAND THIS IS ONLY AN ESTIMATE. MY ACTUAL CHARGES MAY BE DIFFERENT (HIGHER OR LOWER) THAN THE ESTIMATE.
I UNDERSTAND AND AGREE
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