1. I understand that the following charge information is based on historical data and is an average of charges for the service without complications. This set of charges does not include physician fees. Your physician may find it necessary to perform more, fewer, or different procedures at the time of service, your final bill will include charges for the actual services provided to you. For questions about your financial obligation, we encourage you to contact your insurance company to verify the details of your coverage.
2. I understand that a single line item charge may not represent a complete medical service; in general, multiple charge line items are necessary to represent all components of a service (e.g. procedure(s), supplies, and drugs).
3. I understand to receive a more accurate total cost please provide as much information as possible about the specific service or procedure, along with the Physician or Specialist’s name. If your doctor’s office can provide you with the procedure codes or CPT codes, a more accurate estimate can be provided.