Patient Estimates
Disclaimer
I understand that the following standard charges for shoppable service information is based on historical data and is an estimate of charges of the services(s), excluding complications that may arise. I acknowledge that this estimate may not include all associated professional fees or charges for additional services ordered for my care. I understand that my provider may find it necessary to perform more, fewer, or different procedures at the time of service, which will affect my actual cost. My final bill will include charges for the actual services provided to me. I acknowledge that I can contact my insurance company to verify details of my coverage to help me better understand my anticipated financial obligations.