This link leads to the downloadable machine-readable file of all items and services provided by this facility as required by CMS. Please be advised the file size may exceed 1.5 gigabytes and therefore may take an extended amount of time to download depending on each individual user’s internet speed, bandwidth, connectivity, available hard drive space, etc.
This good faith ESTIMATE should not be relied on as the final out-of-pocket cost for services as your final cost will vary based upon your specific needs at the time of the service, including additional treatments or services deemed necessary by the physician and/or additional information provided by your insurer.
This good faith ESTIMATE does not include bills from medical specialists, including by not limited to: physician charges, anesthesiology charges, radiologist reading fees and pathologist fees. Charges from these medical specialists will be billed separately to you.
If you have met all or part of your deductible or maximum out-of-pocket expenses, the actual amount you owe may be different.
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.
Final determination of eligibility and services covered are determined at the time the claim is processed by the insurance company. Any services determined non-covered by your plan are your responsibility to pay.
This good faith ESTIMATE is intended only for the use of the intended recipient. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or action taken in reliance on the contents of these documents is strictly forbidden.
To obtain a fully personalized good faith ESTIMATE contact Customer Service at 435-587-1234.
The final price may be higher or lower based on actual services rendered at time of appointment. It is advised that you contact your health insurer for most accurate individual payment responsibilities and to confirm any applicable remaining deductible balances.
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